Provider Demographics
NPI:1316051501
Name:PRINCE, DIANA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2924
Mailing Address - Country:US
Mailing Address - Phone:707-584-8588
Mailing Address - Fax:707-584-2869
Practice Address - Street 1:1450 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2924
Practice Address - Country:US
Practice Address - Phone:707-584-8588
Practice Address - Fax:707-584-2869
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA63605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18736Medicare UPIN