Provider Demographics
NPI:1790715712
Name:KIRBIS, DIANE GAIL (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:GAIL
Last Name:KIRBIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 ARCOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4810
Mailing Address - Country:US
Mailing Address - Phone:818-762-8601
Mailing Address - Fax:
Practice Address - Street 1:450 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3748
Practice Address - Country:US
Practice Address - Phone:626-254-2253
Practice Address - Fax:626-254-2270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN342528OtherNURSE LICENCE
CANP12911OtherNURSE PRACTIONER LICENSE