Provider Demographics
NPI:1154693893
Name:ALEXIS, DIANA (FNP CDE BC-ADM)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:FNP CDE BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20660 CHATSWORTH STREET
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311
Mailing Address - Country:US
Mailing Address - Phone:818-886-6080
Mailing Address - Fax:818-886-6080
Practice Address - Street 1:21606 DEVONSHIRE STREET, #4646
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91313-7074
Practice Address - Country:US
Practice Address - Phone:818-886-6080
Practice Address - Fax:818-886-6080
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21130363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner