Provider Demographics
NPI:1235914482
Name:TAIZ, DIANA (DMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TAIZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 CALAVO DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1138
Mailing Address - Country:US
Mailing Address - Phone:951-999-7960
Mailing Address - Fax:
Practice Address - Street 1:9862 MISSION GORGE RD STE E
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3873
Practice Address - Country:US
Practice Address - Phone:619-596-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1091681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice