Provider Demographics
NPI:1316335482
Name:REANDINO, DIANNA BERMEJO (RN)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:BERMEJO
Last Name:REANDINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 ARUBA CV UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1313
Mailing Address - Country:US
Mailing Address - Phone:619-386-9665
Mailing Address - Fax:
Practice Address - Street 1:1203 ARUBA CV UNIT 1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1313
Practice Address - Country:US
Practice Address - Phone:619-386-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031002163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse