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General NPI Number Information
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NPI Number | 1154647121
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Entity Type | Individual
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Provider Name | DIANE ALICE ALBA
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Gender | Female
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 230 HIGHLAND AVE
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City | SOMERVILLE
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State | MA
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Zip | 02143-1408
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Country | US
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Telephone | 617-591-4460
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Fax | 617-591-4566
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Provider Business Mailing Address
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Address Line | 230 HIGHLAND AVE
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City | SOMERVILLE
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State | MA
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Zip | 02143-1408
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Country | US
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Telephone | 617-591-4460
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Fax | 617-591-4566
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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 | 163WG0100X
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Taxonomy Name | Gastroenterology Registered Nurse
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License Number | 212972
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License Number State | MA
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