Provider Demographics
NPI:1275907420
Name:DIOMBERA, DIABA (CRNA)
Entity Type:Individual
Prefix:
First Name:DIABA
Middle Name:
Last Name:DIOMBERA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MEADOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5940
Mailing Address - Country:US
Mailing Address - Phone:646-271-0082
Mailing Address - Fax:
Practice Address - Street 1:10 EXCHANGE PL
Practice Address - Street 2:15TH FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3918
Practice Address - Country:US
Practice Address - Phone:201-884-5289
Practice Address - Fax:201-604-6139
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00607400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered