Provider Demographics
NPI:1912249491
Name:PAYAN, DIANNA (DIANNA PAYAN)
Entity Type:Individual
Prefix:MISS
First Name:DIANNA
Middle Name:
Last Name:PAYAN
Suffix:
Gender:F
Credentials:DIANNA PAYAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 S JONES BLVD # 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5642
Mailing Address - Country:US
Mailing Address - Phone:702-476-6395
Mailing Address - Fax:
Practice Address - Street 1:2920 S JONES BLVD # 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5642
Practice Address - Country:US
Practice Address - Phone:702-340-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NVCI773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner