Provider Demographics
NPI:1124576897
Name:CHAVEZ SOSA, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CHAVEZ SOSA
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 1:601 N KEYS RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1172
Mailing Address - Country:US
Mailing Address - Phone:509-225-3383
Mailing Address - Fax:
Practice Address - Street 1:601 N KEYS RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1172
Practice Address - Country:US
Practice Address - Phone:509-225-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60719194163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health