Provider Demographics
NPI:1194826594
Name:FERGUSON, DIANNA P (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:P
Last Name:FERGUSON
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 1:23388 MULHOLLAND DR
Mailing Address - Street 2:MAILSTOP 62
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2733
Mailing Address - Country:US
Mailing Address - Phone:818-556-2700
Mailing Address - Fax:818-563-9459
Practice Address - Street 1:4323 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4044
Practice Address - Country:US
Practice Address - Phone:818-556-2700
Practice Address - Fax:818-563-9459
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G766970OtherBLUE SHIELD
WG77697HMedicare ID - Type Unspecified
CAWG77697GMedicare ID - Type Unspecified
CAWG77697DMedicare ID - Type Unspecified
CA00G766970OtherBLUE SHIELD
G17409Medicare UPIN
CAWG77697FMedicare ID - Type Unspecified