Basic Information
| Provider Information | |||||||||
| NPI: | 1255076220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIORIO | ||||||||
| FirstName: | ANDRAYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9800D TOPANGA CANYON BLVD # 306 | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913114005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067913725 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4955 ALTA ST | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930632452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057913725 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2022 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | CA | N | Other Service Providers | Case Manager/Care Coordinator | 225400000X | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.