Provider Demographics
NPI:1386823318
Name:DIRKS, DIANE MICHELLE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MICHELLE
Last Name:DIRKS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:DEE DEE
Other - Middle Name:
Other - Last Name:DIRKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:1011 BALDWIN PARK BLVD
Mailing Address - Street 2:OB GYN
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5806
Mailing Address - Country:US
Mailing Address - Phone:626-851-1011
Mailing Address - Fax:
Practice Address - Street 1:1011 BALDWIN PARK BLVD
Practice Address - Street 2:OB GYN
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5806
Practice Address - Country:US
Practice Address - Phone:626-851-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife