Provider Demographics
NPI:1053604058
Name:KOROI, DIANA VALLARTA (LM, CPM)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:VALLARTA
Last Name:KOROI
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:RENEE
Other - Last Name:VALLARTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2179
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031
Mailing Address - Country:US
Mailing Address - Phone:408-886-4961
Mailing Address - Fax:408-412-5020
Practice Address - Street 1:967 W. HEDDING ST
Practice Address - Street 2:STE 110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126
Practice Address - Country:US
Practice Address - Phone:408-886-4961
Practice Address - Fax:408-412-5020
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM303176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife