Provider Demographics
NPI:1740661040
Name:MIDKIFF, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MIDKIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6205
Mailing Address - Country:US
Mailing Address - Phone:831-883-7503
Mailing Address - Fax:831-775-8011
Practice Address - Street 1:2620 1ST AVE
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6205
Practice Address - Country:US
Practice Address - Phone:831-883-7503
Practice Address - Fax:831-775-8011
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator