Provider Demographics
NPI:1497155675
Name:DIEZ, NINA ANDREA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:ANDREA
Last Name:DIEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1909
Mailing Address - Country:US
Mailing Address - Phone:650-697-0166
Mailing Address - Fax:650-697-7589
Practice Address - Street 1:615 BROADWAY
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1909
Practice Address - Country:US
Practice Address - Phone:650-697-0166
Practice Address - Fax:650-697-7589
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist