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Individual
KEDIST DIAS
Active
Individual
KEDIST DIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN696069
CA
Other
Enumeration date
10/11/2018
Last updated
10/11/2018
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