Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 122296 | NC |
N | 208600000X | Surgeon | 122296 | NC |
Y | 208200000X | Surgeon | P1453 | TX |
Y | 208600000X | Surgeon | P1453 | TX |
N | 2086S0120X | Pediatric Surgery | P1453 | TX |
NPI | 1457525230 |
---|---|
Provider Name | Diana Leigh Diesen |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2008 |
Last Update Date | 27/08/2013 |