Provider Demographics
NPI:1912382573
Name:DIEGO, AMBER (RT (MR)(R))
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DIEGO
Suffix:
Gender:F
Credentials:RT (MR)(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 N SANTA ANNA CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8327
Mailing Address - Country:US
Mailing Address - Phone:480-388-2514
Mailing Address - Fax:
Practice Address - Street 1:1417 N SANTA ANNA CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8327
Practice Address - Country:US
Practice Address - Phone:480-388-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ140022471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography