Provider Demographics
NPI:1295844058
Name:TARICA, DIANE CHIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:CHIE
Last Name:TARICA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 906
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-207-5700
Mailing Address - Fax:310-207-5710
Practice Address - Street 1:11980 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 906
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-207-5700
Practice Address - Fax:310-207-5710
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics