Provider Demographics
NPI:1942571385
Name:OFINA, DIANA THESSE
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:THESSE
Last Name:OFINA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:OFINA
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:547 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3917
Mailing Address - Country:US
Mailing Address - Phone:702-683-5698
Mailing Address - Fax:
Practice Address - Street 1:547 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3917
Practice Address - Country:US
Practice Address - Phone:702-683-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner