1336215607 NPI number — DR. PAUL DIEHL M.D.

Table of content: DR. PAUL DIEHL M.D. (NPI 1336215607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336215607 NPI number — DR. PAUL DIEHL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEHL
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336215607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92877-0126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-278-5590
Provider Business Mailing Address Fax Number:
951-272-9924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23101 SHERMAN PL
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91307-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-347-1500
Provider Business Practice Location Address Fax Number:
818-347-4119
Provider Enumeration Date:
11/28/2006

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: 207R00000X , with the licence number:  A044437 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A44437 . This is a "MEDICAL STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000A44437 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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