Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A124465 | CA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | A124465 | CA |
NPI | 1376882357 |
---|---|
Provider Name | Dr. Diane Renee Thomas |
First Address | Modesto, CA 95350-1159 |
Second Address | Merced, CA 95348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 24/09/2018 |