Provider Demographics
NPI:1639336084
Name:QUITORIANO, DIANE MARIE (RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:QUITORIANO
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:DE LOS REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:824 OJAI RD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1418
Mailing Address - Country:US
Mailing Address - Phone:805-229-7332
Mailing Address - Fax:805-229-7332
Practice Address - Street 1:2125 KNOLL DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7329
Practice Address - Country:US
Practice Address - Phone:805-981-7640
Practice Address - Fax:805-654-7611
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA686985163W00000X
CA71745163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse