Provider Demographics
NPI:1215097241
Name:DIEL, JAMES ROBERT (MED)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:DIEL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6591
Mailing Address - Country:US
Mailing Address - Phone:530-747-3336
Mailing Address - Fax:530-753-0398
Practice Address - Street 1:2100 5TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6591
Practice Address - Country:US
Practice Address - Phone:530-747-3336
Practice Address - Fax:530-753-0398
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist