Provider Demographics
NPI:1538294103
Name:PAUL E. DIEHL, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAUL E. DIEHL, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-347-1500
Mailing Address - Street 1:PO BOX 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:951-278-5590
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:23101 SHERMAN PL STE 302
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2047
Practice Address - Country:US
Practice Address - Phone:818-347-1500
Practice Address - Fax:818-347-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A44437Medicaid
CAA44437OtherMEDICAL STATE LICENSE
CAA44437OtherMEDICAL STATE LICENSE
CA000A44437Medicaid