Provider Demographics
NPI:1356557888
Name:SHIBA, DIANA REIKO (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:REIKO
Last Name:SHIBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:626-495-5725
Mailing Address - Fax:
Practice Address - Street 1:9415 CAMPUS POINT DR # 257
Practice Address - Street 2:MC (0946)
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0946
Practice Address - Country:US
Practice Address - Phone:858-336-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99649207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology