Provider Demographics
NPI:1023134046
Name:DIAZ, DOREEN KIMIYO (RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:KIMIYO
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-453-5200
Mailing Address - Fax:
Practice Address - Street 1:215 N FRESNO STREET
Practice Address - Street 2:SUITE 370
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701
Practice Address - Country:US
Practice Address - Phone:559-459-4543
Practice Address - Fax:559-459-1524
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered