Healthcare Provider Details

I. General information

NPI: 1841633377
Provider Name (Legal Business Name): VIVIAN T DIAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22803 NORTHRIDGE TERRACE CT
SPRING TX
77373-5685
US

IV. Provider business mailing address

22803 NORTHRIDGE TERRACE CT
SPRING TX
77373-5685
US

V. Phone/Fax

Practice location:
  • Phone: 281-723-9442
  • Fax: 877-773-4140
Mailing address:
  • Phone: 281-723-9442
  • Fax: 877-773-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: