Provider Demographics
NPI:1154051142
Name:CARDONA GIRALDO, DIANA LORENA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LORENA
Last Name:CARDONA GIRALDO
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 1:3080 GLADEWATER CT
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9547
Mailing Address - Country:US
Mailing Address - Phone:336-406-8026
Mailing Address - Fax:
Practice Address - Street 1:3080 GLADEWATER CT
Practice Address - Street 2:
Practice Address - City:PFAFFTOWN
Practice Address - State:NC
Practice Address - Zip Code:27040-9547
Practice Address - Country:US
Practice Address - Phone:336-406-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13627224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant