Provider Demographics
NPI:1639799620
Name:NABOULSI, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NABOULSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 CAMINITO BAYO
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7189
Mailing Address - Country:US
Mailing Address - Phone:916-990-5423
Mailing Address - Fax:
Practice Address - Street 1:5203 CAMINITO CACHORRO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5357
Practice Address - Country:US
Practice Address - Phone:916-990-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator