Provider Demographics
NPI:1700077245
Name:BUI, DIANE T (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:T
Last Name:BUI
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:39765 DATE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2005
Mailing Address - Country:US
Mailing Address - Phone:951-894-4665
Mailing Address - Fax:951-894-5178
Practice Address - Street 1:39765 DATE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2005
Practice Address - Country:US
Practice Address - Phone:951-894-4665
Practice Address - Fax:951-894-5178
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2011-11-04
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Provider Licenses
StateLicense IDTaxonomies
CA20A9296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9296OtherSTATE LICENSE
CA020A92960OtherBLUE SHIELD OF CA
CA20A9296OtherSTATE LICENSE