Provider Demographics
NPI:1689493264
Name:ZAPATA-OSPINA, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ZAPATA-OSPINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 S GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7161
Mailing Address - Country:US
Mailing Address - Phone:725-745-3741
Mailing Address - Fax:
Practice Address - Street 1:4245 S GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7161
Practice Address - Country:US
Practice Address - Phone:725-745-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NVCHW1-5948172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant