1265095954 NPI number — MS. KRISTIN CAROL DIASIO MS SPECIAL EDUCATION

Table of content: MS. KRISTIN CAROL DIASIO MS SPECIAL EDUCATION (NPI 1265095954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265095954 NPI number — MS. KRISTIN CAROL DIASIO MS SPECIAL EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIASIO
Provider First Name:
KRISTIN
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS SPECIAL EDUCATION
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHARGUALAF
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA SOCIOLOGY
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265095954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 MEDFORD CTR # 264
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504-6772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-816-4415
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 ERICKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHADY COVE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97539-9758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-816-4415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1386091569 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".