MEDICARE: DIANA DETCHEVA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95046769	CA

General Provider Information

NPI Number	:	1801477765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA DETCHEVA RN

Provider Business Mailing Address
First Line	:	15593 OAKDALE RD
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2439
Country	:	US
Telephone Number	:	818-288-6882
Fax Number	:

Provider Business Practice Location Address
First Line	:	15593 OAKDALE RD
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2439
Country	:	US
Telephone Number	:	818-288-6882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/20/2021

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