Provider Demographics
NPI:1457678880
Name:SEPEHRI-HARVEY, DIANA (DO)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:SEPEHRI-HARVEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 GOLD MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4405
Mailing Address - Country:US
Mailing Address - Phone:916-999-5875
Mailing Address - Fax:
Practice Address - Street 1:2377 GOLD MEADOW WAY
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4405
Practice Address - Country:US
Practice Address - Phone:916-999-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-25
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3264207Q00000X
VA0102204379207Q00000X
CA20A11956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457678880Medicaid
VA1457678880Medicaid
VAVVK035AMedicare PIN