Provider Demographics
NPI:1376188920
Name:LE, DIANNA M (CPO, MSOP)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:M
Last Name:LE
Suffix:
Gender:F
Credentials:CPO, MSOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-1733
Mailing Address - Country:US
Mailing Address - Phone:671-682-0140
Mailing Address - Fax:
Practice Address - Street 1:347 W OBRIEN DR STE 1
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5050
Practice Address - Country:US
Practice Address - Phone:671-682-0140
Practice Address - Fax:671-969-2726
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist