Provider Demographics
NPI:1710296892
Name:DE DIOS, DIANA (OPTOMETRIST)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:DE DIOS
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 PACIFIC BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2950
Mailing Address - Country:US
Mailing Address - Phone:323-923-9001
Mailing Address - Fax:323-923-9345
Practice Address - Street 1:6001 PACIFIC BLVD STE 128
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2950
Practice Address - Country:US
Practice Address - Phone:323-923-9001
Practice Address - Fax:323-923-9345
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist