Provider Demographics
NPI:1568055705
Name:LEET, DIANA (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LEET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8889 CAMINITO PLAZA CENTRO UNIT 7420
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1017
Mailing Address - Country:US
Mailing Address - Phone:203-506-1993
Mailing Address - Fax:
Practice Address - Street 1:5644 MISSION CENTER RD # 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4328
Practice Address - Country:US
Practice Address - Phone:619-298-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95186101163W00000X
CT140296163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical