Provider Demographics
NPI:1649208638
Name:KECSKES, DIANE W (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:W
Last Name:KECSKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:732 N RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0329
Mailing Address - Country:US
Mailing Address - Phone:559-289-6853
Mailing Address - Fax:559-299-2587
Practice Address - Street 1:2550 W CLINTON AVE BLDG A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4206
Practice Address - Country:US
Practice Address - Phone:559-264-7521
Practice Address - Fax:559-233-0016
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0749512084P0005X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG074951Medicaid
CA00G749510Medicare ID - Type Unspecified
CAG074951Medicaid