Provider Demographics
NPI:1457705857
Name:RODARTE, DIANA JOVANNIE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JOVANNIE
Last Name:RODARTE
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 1:14945 TIM HARDAWAY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-3161
Mailing Address - Country:US
Mailing Address - Phone:760-450-7090
Mailing Address - Fax:
Practice Address - Street 1:14945 TIM HARDAWAY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-3161
Practice Address - Country:US
Practice Address - Phone:760-450-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician