Provider Demographics
NPI:1013104876
Name:ZULUETA, DIANA A (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:A
Last Name:ZULUETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NORTH HAMPTON RD
Mailing Address - Street 2:# 205
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:469-585-1297
Mailing Address - Fax:972-499-1364
Practice Address - Street 1:1801 NORTH HAMPTON RD
Practice Address - Street 2:# 205
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:469-585-1297
Practice Address - Fax:972-499-1364
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE79698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine