Provider Demographics
NPI:1528012085
Name:MOROF, DIANE FAY (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:FAY
Last Name:MOROF
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 1:482 W MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2826
Mailing Address - Country:US
Mailing Address - Phone:650-601-4705
Mailing Address - Fax:510-547-7446
Practice Address - Street 1:482 W MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2826
Practice Address - Country:US
Practice Address - Phone:650-601-4705
Practice Address - Fax:510-547-7446
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A872660Medicaid
CA00A872660Medicaid
CA00A872660Medicare ID - Type Unspecified