Provider Demographics
NPI:1336215607
Name:DIEHL, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DIEHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:951-278-5590
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:STE 302
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2047
Practice Address - Country:US
Practice Address - Phone:818-347-1500
Practice Address - Fax:818-347-4119
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44437OtherMEDICAL STATE LICENSE
CA000A44437Medicaid
CAF01166Medicare UPIN
CA000A44437Medicaid