Healthcare Provider Details

I. General information

NPI: 1104381110
Provider Name (Legal Business Name): DIANA CORREAVELOSA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7614 N FRESNO ST STE 105
FRESNO CA
93720-7406
US

IV. Provider business mailing address

7614 N FRESNO ST STE 105
FRESNO CA
93720-7406
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-3344
  • Fax: 559-435-6658
Mailing address:
  • Phone: 559-435-3344
  • Fax: 559-435-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DIEGO F VELOSA
Title or Position: DIRECTOR
Credential:
Phone: 559-435-3444