Provider Demographics
NPI:1417146366
Name:PRIMAK, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:PRIMAK
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 1:7805 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2115
Mailing Address - Country:US
Mailing Address - Phone:916-726-1803
Mailing Address - Fax:916-726-8903
Practice Address - Street 1:7805 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2115
Practice Address - Country:US
Practice Address - Phone:916-726-1803
Practice Address - Fax:916-726-8903
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide