MEDICARE: MISS DIANNA PAYAN DIANNA PAYAN

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	225400000X	Rehabilitation Practitioner
2	101YM0800X	Mental Health Counselor	CI773	NV

General Provider Information

NPI Number	:	1912249491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DIANNA PAYAN DIANNA PAYAN

Provider Business Mailing Address
First Line	:	2920 S JONES BLVD # 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5642
Country	:	US
Telephone Number	:	702-476-6395
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 S JONES BLVD # 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5642
Country	:	US
Telephone Number	:	702-340-1910
Fax Number	:

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

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/18/2020

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