Provider Demographics
NPI:1891274734
Name:PEQUENO, DIANE RODRIGUEZ (LVN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:RODRIGUEZ
Last Name:PEQUENO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SPOONER ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-2426
Mailing Address - Country:US
Mailing Address - Phone:832-971-6194
Mailing Address - Fax:
Practice Address - Street 1:15014 ROCKINGTON LN
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-2295
Practice Address - Country:US
Practice Address - Phone:832-971-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134837164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty