Provider Demographics
NPI:1710996830
Name:DIEBEL, RONALD C (MD)
Entity Type:Individual
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First Name:RONALD
Middle Name:C
Last Name:DIEBEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1101 S WINCHESTER BLVD STE D146
Mailing Address - Street 2:RONALD C. DIEBEL, M.D. A PROFESSIONAL CORPORATION
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3915
Mailing Address - Country:US
Mailing Address - Phone:408-314-5000
Mailing Address - Fax:408-287-7847
Practice Address - Street 1:1101 SOUTH WINCHESTER BLVD. SUITE D 146
Practice Address - Street 2:RONALD C DIEBEL, MD A PROFESSIONAL CORPORATION
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-314-5000
Practice Address - Fax:408-287-7847
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-09-19
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Provider Licenses
StateLicense IDTaxonomies
CAG197852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G19785Medicare UPIN