Provider Demographics
NPI:1568789097
Name:ALLENDE, DIEGO G (DO)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:G
Last Name:ALLENDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5446
Mailing Address - Country:US
Mailing Address - Phone:559-435-5727
Mailing Address - Fax:559-435-5503
Practice Address - Street 1:6234 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5446
Practice Address - Country:US
Practice Address - Phone:559-435-5727
Practice Address - Fax:559-435-5503
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7611OtherCA. LICENSE