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General NPI Number Information
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NPI Number | 1114998184
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Entity Type | Individual
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Provider Name | DIANE LIBERTO DAVIS MSN, FNP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BOX 153
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City | SAN DIEGO
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State | CA
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Zip | 92136-5153
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Country | US
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Telephone | 619-556-8475
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 182208
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City | CORONADO
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State | CA
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Zip | 92178-2208
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Country | US
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Telephone | 619-556-8475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9671
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License Number State | CA
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