Provider Demographics
NPI:1356833198
Name:DEMASI, DIANA DENISE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DENISE
Last Name:DEMASI
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 1:3020 SCENIC HILLS CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-2820
Mailing Address - Country:US
Mailing Address - Phone:817-600-6086
Mailing Address - Fax:
Practice Address - Street 1:4411 LEMMON AVE STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2390
Practice Address - Country:US
Practice Address - Phone:817-660-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty