Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | G40195 | CA |
NPI | 1316947351 |
---|---|
Provider Name | Lynne Marie Diamond |
First Address | Pomona, CA 91767-3027 |
Second Address | Pomona, CA 91767-3027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AD9754082 | DEA # (01) | |
C15214 | (02) | |
G40195 | MEDICAL LICENSE (01) | CA |