Provider Demographics
NPI:1225067812
Name:COLE, DYAN (MD)
Entity type:Individual
Prefix:
First Name:DYAN
Middle Name:
Last Name:COLE
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 1:3517 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-4358
Mailing Address - Country:US
Mailing Address - Phone:805-746-2781
Mailing Address - Fax:
Practice Address - Street 1:3517 SUNSET LN
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-4358
Practice Address - Country:US
Practice Address - Phone:805-746-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67490207Q00000X
AZTP00979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G674900Medicaid
CA0G674903Medicare ID - Type Unspecified
CA00G674900Medicaid