Provider Demographics
NPI:1548409220
Name:NATHAN, DIANNA L (AUD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:NATHAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 G ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3604
Mailing Address - Country:US
Mailing Address - Phone:619-425-9600
Mailing Address - Fax:
Practice Address - Street 1:540 G ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3604
Practice Address - Country:US
Practice Address - Phone:619-425-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2626231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist