Provider Demographics
NPI:1477569093
Name:VANEK, DIANE (DPM)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:VANEK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:BABROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 27829
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125
Mailing Address - Country:US
Mailing Address - Phone:505-232-1920
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:5400 GIBSON SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-262-7000
Practice Address - Fax:505-262-7147
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM303213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist