Provider Demographics
NPI:1861816464
Name:DYAS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DYAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35270 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8705
Mailing Address - Country:US
Mailing Address - Phone:619-540-5252
Mailing Address - Fax:
Practice Address - Street 1:35270 SLATER AVENUE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8705
Practice Address - Country:US
Practice Address - Phone:619-540-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN171863164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse