Provider Demographics
NPI:1780069054
Name:URIBE-TANUS, DIANA AURORA (RDN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:AURORA
Last Name:URIBE-TANUS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43651 DEVYN LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-5858
Mailing Address - Country:US
Mailing Address - Phone:818-284-1818
Mailing Address - Fax:661-760-2428
Practice Address - Street 1:43651 DEVYN LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-5858
Practice Address - Country:US
Practice Address - Phone:818-284-1818
Practice Address - Fax:661-760-2428
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052382133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered