Provider Demographics
NPI:1851079354
Name:ALIAV, DIANNA REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:REBECCA
Last Name:ALIAV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24301 BESSEMER ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1110
Mailing Address - Country:US
Mailing Address - Phone:818-570-3170
Mailing Address - Fax:
Practice Address - Street 1:277 HAMPSHIRE RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-2408
Practice Address - Country:US
Practice Address - Phone:805-495-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist