Provider Demographics
NPI:1053880880
Name:MALABANAN, DIANNE JAVIER (MSN, FNP-BC, NP-C)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:JAVIER
Last Name:MALABANAN
Suffix:
Gender:F
Credentials:MSN, FNP-BC, NP-C
Other - Prefix:
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Mailing Address - Street 1:2175 CONDOR DR UNIT 47
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2904
Mailing Address - Country:US
Mailing Address - Phone:858-204-6897
Mailing Address - Fax:
Practice Address - Street 1:1730 ALPINE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3878
Practice Address - Country:US
Practice Address - Phone:619-326-4445
Practice Address - Fax:619-722-1721
Is Sole Proprietor?:No
Enumeration Date:2018-11-22
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95010345363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner