Provider Demographics
NPI:1386823318
Name:DIRKS, DIANE MICHELLE (CNM)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MICHELLE
Last Name:DIRKS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:DEE DEE
Other - Middle Name:
Other - Last Name:DIRKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 380
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2179
Practice Address - Country:US
Practice Address - Phone:310-899-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342536176B00000X, 207V00000X
CA722207V00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology