Healthcare Provider Details

I. General information

NPI: 1780205823
Provider Name (Legal Business Name): DIAO NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8972 FRASURE FALLS AVE
LAS VEGAS NV
89178-7215
US

IV. Provider business mailing address

8972 FRASURE FALLS AVE
LAS VEGAS NV
89178-7215
US

V. Phone/Fax

Practice location:
  • Phone: 702-768-1109
  • Fax:
Mailing address:
  • Phone: 702-768-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA ZARINA DIAO
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 702-768-1109