Provider Demographics
NPI:1740028778
Name:CANALES-CRUZ, DIANA IDALIA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:IDALIA
Last Name:CANALES-CRUZ
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 1:3230 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3823
Mailing Address - Country:US
Mailing Address - Phone:775-857-5419
Mailing Address - Fax:
Practice Address - Street 1:3230 HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3823
Practice Address - Country:US
Practice Address - Phone:775-857-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide