Provider Demographics
NPI:1932649910
Name:PAVIA, DIANNE CHRISTINE SISON (RN)
Entity Type:Individual
Prefix:
First Name:DIANNE CHRISTINE
Middle Name:SISON
Last Name:PAVIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:S
Other - Last Name:PAVIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3851 ROSECRANS ST. SUITE 128
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:619-692-8623
Mailing Address - Fax:
Practice Address - Street 1:3851 ROSECRANS ST STE 128
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA831938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse