Provider Demographics
NPI:1104669050
Name:WASHINGTON, DIVA MARIE
Entity type:Individual
Prefix:
First Name:DIVA
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 FEBRUARY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-3023
Mailing Address - Country:US
Mailing Address - Phone:469-494-8433
Mailing Address - Fax:
Practice Address - Street 1:2333 FEBRUARY LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3023
Practice Address - Country:US
Practice Address - Phone:469-494-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver