Provider Demographics
NPI:1689451007
Name:PHAN, DIANA ELIZABETH (ND)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:ELIZABETH
Last Name:PHAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 DUCOS PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3024
Mailing Address - Country:US
Mailing Address - Phone:714-722-5052
Mailing Address - Fax:
Practice Address - Street 1:5009 DUCOS PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-3024
Practice Address - Country:US
Practice Address - Phone:714-722-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath