Provider Demographics
NPI:1942009170
Name:MARMOLEJO, DIANA LUZ
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LUZ
Last Name:MARMOLEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47800 MADISON ST UNIT 145
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-6679
Mailing Address - Country:US
Mailing Address - Phone:760-844-5924
Mailing Address - Fax:
Practice Address - Street 1:3933 HARRISON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3523
Practice Address - Country:US
Practice Address - Phone:833-391-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program