Provider Demographics
NPI:1518750736
Name:FERNANDEZ SANTIESTEBAN, DIANELLY
Entity type:Individual
Prefix:
First Name:DIANELLY
Middle Name:
Last Name:FERNANDEZ SANTIESTEBAN
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 1:12814 N 115TH LN
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3963
Mailing Address - Country:US
Mailing Address - Phone:602-366-5548
Mailing Address - Fax:
Practice Address - Street 1:250 PILOT RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3542
Practice Address - Country:US
Practice Address - Phone:725-334-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV889996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse