Provider Demographics
NPI:1063225423
Name:VEGA CARDONA, DIANNI
Entity type:Individual
Prefix:
First Name:DIANNI
Middle Name:
Last Name:VEGA CARDONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15730 LAKEDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3633
Mailing Address - Country:US
Mailing Address - Phone:832-952-7290
Mailing Address - Fax:
Practice Address - Street 1:15730 LAKEDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3633
Practice Address - Country:US
Practice Address - Phone:832-952-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22-244168106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician