Provider Demographics
NPI:1467635466
Name:RONALD C. DIEBEL, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RONALD C. DIEBEL, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-314-5000
Mailing Address - Street 1:1101 S WINCHESTER BLVD. STE. D-146
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3915
Mailing Address - Country:US
Mailing Address - Phone:408-314-5000
Mailing Address - Fax:408-287-7847
Practice Address - Street 1:251 OCONNOR DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1656
Practice Address - Country:US
Practice Address - Phone:408-314-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2084P0800X
CAG19786332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG19785OtherMEDICAL LICENSE NUMBER
CA00G19785Medicare UPIN