Provider Demographics
NPI:1164965091
Name:CUPP, DIANA MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:CUPP
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:WOHLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 W METROPOLITAN DR # 120
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3504
Mailing Address - Country:US
Mailing Address - Phone:714-972-3700
Mailing Address - Fax:
Practice Address - Street 1:4000 W METROPOLITAN DR # 120
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:714-972-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-26
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily