Provider Demographics
NPI:1700869476
Name:BASTIAN, DIANNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:M
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9100 N 2ND ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2446
Mailing Address - Country:US
Mailing Address - Phone:602-997-7331
Mailing Address - Fax:602-870-4512
Practice Address - Street 1:9100 N 2ND ST
Practice Address - Street 2:SUITE 121
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2446
Practice Address - Country:US
Practice Address - Phone:602-997-7331
Practice Address - Fax:602-870-4512
Is Sole Proprietor?:No
Enumeration Date:2005-11-27
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine