Provider Demographics
NPI:1033967278
Name:NEVAREZ, DIANA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-4250
Mailing Address - Country:US
Mailing Address - Phone:951-654-8600
Mailing Address - Fax:
Practice Address - Street 1:962 OVERTON DR
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-4250
Practice Address - Country:US
Practice Address - Phone:951-654-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00017501247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty