Provider Demographics
NPI:1528484086
Name:DIOP, NDIAWAR
Entity type:Individual
Prefix:
First Name:NDIAWAR
Middle Name:
Last Name:DIOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27753 LAFAYETTE WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5714
Mailing Address - Country:US
Mailing Address - Phone:951-801-2205
Mailing Address - Fax:951-801-2205
Practice Address - Street 1:27753 LAFAYETTE WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5714
Practice Address - Country:US
Practice Address - Phone:951-801-2205
Practice Address - Fax:951-801-2205
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 226848164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse