=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841009818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIA HEALTH VISIONARIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2025
-----------------------------------------------------
Last Update Date | 01/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 TRUXTUN AVE STE 102
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-310-2305
-----------------------------------------------------
Fax | 661-310-0114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 TRUXTUN AVE STE 102
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-310-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | GRACE OMISORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-310-0107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------