Provider Demographics
NPI:1568507168
Name:NORMAN, DIANNA LEE (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LEE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8810 JAMACHA BLVD
Mailing Address - Street 2:#C212
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5615
Mailing Address - Country:US
Mailing Address - Phone:619-307-9769
Mailing Address - Fax:
Practice Address - Street 1:165 S FIRST STREET
Practice Address - Street 2:
Practice Address - City:EL CAJAN
Practice Address - State:CA
Practice Address - Zip Code:92019
Practice Address - Country:US
Practice Address - Phone:619-312-0347
Practice Address - Fax:619-749-5480
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine