Provider Demographics
NPI:1922080506
Name:DIEGO, SILVIA MARGARITA (MD)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:MARGARITA
Last Name:DIEGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1317 OAKDALE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3361
Mailing Address - Country:US
Mailing Address - Phone:209-522-3362
Mailing Address - Fax:209-522-3363
Practice Address - Street 1:1317 OAKDALE RD
Practice Address - Street 2:STE 440
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3361
Practice Address - Country:US
Practice Address - Phone:209-522-3362
Practice Address - Fax:209-522-3363
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA087804OtherBOARD CERTIFICATION #
CA00A549440OtherBLUE SHIELD OF CA PIN
CA087804OtherBOARD CERTIFICATION #
CAG49274Medicare UPIN