Basic Information
Provider Information
NPI: 1780320150
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POIANA
FirstName: DIANA
MiddleName:  
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Credential:  
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Mailing Information
Address1: 265 VISTA GRANDE GLN
Address2:  
City: ESCONDIDO
State: CA
PostalCode: 920257021
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3111 CAMINO DEL RIO N STE 1200
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921085747
CountryCode: US
TelephoneNumber: 6192999350
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/09/2022
LastUpdateDate: 05/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 05/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
156F00000X  Y Eye and Vision Services ProvidersTechnician/Technologist 

No ID Information.


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