Provider Demographics
NPI:1457158321
Name:RALEY, DIANA (PRSS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RALEY
Suffix:
Gender:
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5584 S FORT APACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7657
Mailing Address - Country:US
Mailing Address - Phone:702-849-9226
Mailing Address - Fax:
Practice Address - Street 1:5584 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7657
Practice Address - Country:US
Practice Address - Phone:702-849-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPRSS-5302175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist