Provider Demographics
NPI:1902610983
Name:WEIL, DIANA (CNS, CD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WEIL
Suffix:
Gender:F
Credentials:CNS, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E COATSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1927
Mailing Address - Country:US
Mailing Address - Phone:801-910-4285
Mailing Address - Fax:
Practice Address - Street 1:222 E COATSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1927
Practice Address - Country:US
Practice Address - Phone:801-910-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13786725-4901133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist