Provider Demographics
NPI:1437343415
Name:CORREA-VELOSA, DIANA CRISTINA (DDS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:CRISTINA
Last Name:CORREA-VELOSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 N. FRESNO STREET
Mailing Address - Street 2:STE. 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-435-3344
Mailing Address - Fax:559-435-6658
Practice Address - Street 1:7614 N. FRESNO STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-435-3344
Practice Address - Fax:559-435-3344
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56250122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice