Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G254-01 | CA |
NPI | 1033463401 |
---|---|
Provider Name | Carole M Diamond |
First Address | Crystal Bay, NV 89402 |
Second Address | Crystal Bay, NV 89402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2012 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90938 | (02) |