Provider Demographics
NPI:1760466312
Name:CHANDLER, DIANE B (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:B
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:5161 CLAYTON RD
Practice Address - Street 2:#F
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3191
Practice Address - Country:US
Practice Address - Phone:925-609-8282
Practice Address - Fax:925-609-8826
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01451503OtherRAILROAD MEDICARE
CAI17066Medicare UPIN
CAP01451503OtherRAILROAD MEDICARE