Basic Information
| Provider Information | |||||||||
| NPI: | 1205415551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAUBER | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | TOSHIYE | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1985 PENNGROVE ST | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930652373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055588586 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER | ||||||||
| Address2: | 16360 ROSCOE BLVD | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014830 | ||||||||
| FaxNumber: | 8189018985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2021 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 164X00000X | VN225233 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.