Healthcare Provider Details

I. General information

NPI: 1265019061
Provider Name (Legal Business Name): MYLENE DIAMAT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 H ST STE 202
CHULA VISTA CA
91910-5547
US

IV. Provider business mailing address

2017 QUARTET LOOP UNIT 1
CHULA VISTA CA
91915-2720
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-4546
  • Fax:
Mailing address:
  • Phone: 949-386-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019995
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95181021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: