Provider Demographics
NPI:1033177167
Name:FARMER, DIANA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:FARMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 STOCKTON BLVD.
Mailing Address - Street 2:CYPRESS #3112
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1418
Mailing Address - Country:US
Mailing Address - Phone:916-734-3190
Mailing Address - Fax:916-734-5119
Practice Address - Street 1:2221 STOCKTON BLVD.
Practice Address - Street 2:CYPRESS #3112
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1418
Practice Address - Country:US
Practice Address - Phone:916-734-3190
Practice Address - Fax:916-734-5119
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62158208600000X, 2086S0120X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G6215800Medicaid
CA0G6215800Medicaid
CA0G6215800Medicare PIN