Provider Demographics
NPI:1669544193
Name:DIANA WARREN, D.O., P.C.
Entity type:Organization
Organization Name:DIANA WARREN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:WALDROP
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:661-412-7784
Mailing Address - Street 1:4580 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1104
Mailing Address - Country:US
Mailing Address - Phone:661-327-4411
Mailing Address - Fax:
Practice Address - Street 1:4580 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1104
Practice Address - Country:US
Practice Address - Phone:661-327-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO523207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A11316OtherSTATE LICENSE
AL051516753Medicaid
CA20A11316OtherSTATE LICENSE
ALG75727Medicare UPIN