Provider Demographics
NPI:1194713107
Name:SIPKIN, DIANE LOUISE (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:SIPKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-4141
Mailing Address - Country:US
Mailing Address - Phone:916-444-3429
Mailing Address - Fax:
Practice Address - Street 1:6000 J ST
Practice Address - Street 2:SACRAMENTO STATE STUDENT HEALTH CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2605
Practice Address - Country:US
Practice Address - Phone:916-278-6461
Practice Address - Fax:916-278-7359
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine