Provider Demographics
NPI:1508937541
Name:GRUBER, DIANE R (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:GRUBER
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 1:441 N LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3028
Mailing Address - Country:US
Mailing Address - Phone:888-988-2800
Mailing Address - Fax:
Practice Address - Street 1:441 N LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3028
Practice Address - Country:US
Practice Address - Phone:888-988-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71548208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery