Provider Demographics
NPI:1881405017
Name:FARIAS, DIANNA R
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:R
Last Name:FARIAS
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 1:36171 LA SALLE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-2368
Mailing Address - Country:US
Mailing Address - Phone:510-943-7135
Mailing Address - Fax:
Practice Address - Street 1:5715 MUSICK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-2554
Practice Address - Country:US
Practice Address - Phone:510-818-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker