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NPI Code Detail

MEDICARE: DIANNA P FERGUSON M.D.

MEDICARE: DIANNA P FERGUSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianG77697CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G766970OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1194826594
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNA P FERGUSON M.D.
Provider Business Mailing Address
First Line : 23388 MULHOLLAND DR
Second Line : MAILSTOP 62
City : WOODLAND HILLS
State : CA
Zip : 91364-2733
Country : US
Telephone Number : 818-556-2700
Fax Number : 818-563-9459
Provider Business Practice Location Address
First Line : 4323 W RIVERSIDE DR
Second Line :
City : BURBANK
State : CA
Zip : 91505-4044
Country : US
Telephone Number : 818-556-2700
Fax Number : 818-563-9459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 11/30/2021

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