Healthcare Provider Details

I. General information

NPI: 1629753348
Provider Name (Legal Business Name): DIANA LUCIA SILVA CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 HOLLY AVE NE
ALBUQUERQUE NM
87113-2472
US

IV. Provider business mailing address

4837 LOS SERRANOS CT NW
ALBUQUERQUE NM
87120-2807
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-2505
  • Fax:
Mailing address:
  • Phone: 505-554-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number74144
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: