Provider Demographics
NPI:1942799887
Name:PRICE, DIANA FAIR (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:FAIR
Last Name:PRICE
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 TRAVISO CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-7071
Mailing Address - Country:US
Mailing Address - Phone:925-337-4069
Mailing Address - Fax:
Practice Address - Street 1:641 TRAVISO CIR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-7071
Practice Address - Country:US
Practice Address - Phone:925-337-4069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA723486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty