Individual
DIANA MARIE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1124 N SANDALWOOD AVE, RIALTO, CA 92376-3848
(909) 838-6408
Mailing address
1124 N SANDALWOOD AVE, RIALTO, CA 92376-3848
(909) 838-6408
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
XXXXXXXXXX
CA
101YS0200X
School Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6990202
KAISER
CA
Enumeration date
01/16/2018
Last updated
06/16/2018
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