Healthcare Provider Details

I. General information

NPI: 1073230033
Provider Name (Legal Business Name): RIANE NICOLE DIANCIN CUEVAS MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIANE NICOLE LUAGUE DIANCIN

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W BEN WHITE BLVD
AUSTIN TX
78704-6903
US

IV. Provider business mailing address

4201 MONTEREY OAKS BLVD APT 1206
AUSTIN TX
78749-1030
US

V. Phone/Fax

Practice location:
  • Phone: 512-816-7160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16307
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: