Provider Demographics
NPI:1760113351
Name:JO, DIANA LE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LE
Last Name:JO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4285 E SUMMER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2842
Mailing Address - Country:US
Mailing Address - Phone:714-883-3550
Mailing Address - Fax:
Practice Address - Street 1:4285 E SUMMER CREEK LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2842
Practice Address - Country:US
Practice Address - Phone:714-883-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist