Provider Demographics
NPI:1609504638
Name:PRIMOS, DIANA (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:PRIMOS
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WILLIAM BEAUMONT ARMY HOSPITAL
Mailing Address - Street 2:18511 HIGHLANDER MEDICS STREET
Mailing Address - City:FT. BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:915-569-3213
Mailing Address - Fax:
Practice Address - Street 1:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Practice Address - Street 2:18511 HIGHLANDER MEDICS STREET
Practice Address - City:FT. BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-569-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical