Provider Demographics
NPI:1740353614
Name:KOHEN-DINIAK, CAROLE GAIL (D O)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:GAIL
Last Name:KOHEN-DINIAK
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ARROWHEAD PEDIATRICS MEDICAL GROUP
Mailing Address - Street 2:400 NORTH PEPPER AVENUE, 2 MOB 203
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-580-3380
Mailing Address - Fax:909-580-6361
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-3380
Practice Address - Fax:909-580-6361
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G34748Medicare UPIN