Provider Demographics
NPI:1104381110
Name:DIANA CORREAVELOSA DDS INC
Entity type:Organization
Organization Name:DIANA CORREAVELOSA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:F
Authorized Official - Last Name:VELOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-435-3444
Mailing Address - Street 1:7614 N FRESNO ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-7406
Mailing Address - Country:US
Mailing Address - Phone:559-435-3344
Mailing Address - Fax:559-435-6658
Practice Address - Street 1:7614 N FRESNO ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-7406
Practice Address - Country:US
Practice Address - Phone:559-435-3344
Practice Address - Fax:559-435-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty