Provider Demographics
NPI:1285739698
Name:SOBKOWICZ, DIANE (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SOBKOWICZ
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 1:30 GARDEN CT
Mailing Address - Street 2:# B
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5302
Mailing Address - Country:US
Mailing Address - Phone:831-647-1123
Mailing Address - Fax:
Practice Address - Street 1:3262 FORTUNE CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602
Practice Address - Country:US
Practice Address - Phone:530-885-8758
Practice Address - Fax:530-889-9440
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G513000Medicaid
CA00G513000OtherBLUE SHIELD PIN
00G513001Medicare PIN
CA00G513000OtherBLUE SHIELD PIN