Provider Demographics
NPI:1417994708
Name:DIALLO, DIANNA (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:DIALLO
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 1:2 UPPER RAGSDALE DR STE B210
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7851
Mailing Address - Country:US
Mailing Address - Phone:831-333-0999
Mailing Address - Fax:831-333-0909
Practice Address - Street 1:2 UPPER RAGSDALE DR STE B210
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7851
Practice Address - Country:US
Practice Address - Phone:831-333-0999
Practice Address - Fax:831-333-0909
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI34283Medicare UPIN