Basic Information
| Provider Information | |||||||||
| NPI: | 1255804464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIBIRAN | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | BADEO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1851 N GREEN VALLEY PKWY APT 1714 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890745806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024974925 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6363 S PECOS RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891206293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028502691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | RBT-18-69474 | CA | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 106S00000X | RBT-18-69474 | CA | Y |
No ID Information.