Healthcare Provider Details

I. General information

NPI: 1952794893
Provider Name (Legal Business Name): BERNADETTE ROSEANNE DIEGNAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE STE 110
GLENDALE AZ
85304-1273
US

IV. Provider business mailing address

2323 W ROSE GARDEN LN
PHOENIX AZ
85027-2530
US

V. Phone/Fax

Practice location:
  • Phone: 623-847-2000
  • Fax:
Mailing address:
  • Phone: 602-521-6252
  • Fax: 623-842-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number007637
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: