Basic Information
| Provider Information | |||||||||
| NPI: | 1750809703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINARES | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | MERCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5650 JILLSON ST | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232014516 | ||||||||
| FaxNumber: | 3233150170 | ||||||||
| Practice Location | |||||||||
| Address1: | 3590 E IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626615989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2017 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | 83644 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 104100000X | 05 | CA | MEDICAID |