Healthcare Provider Details

I. General information

NPI: 1891226585
Provider Name (Legal Business Name): RICKI DIAMOND DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15351 W BELL RD
SURPRISE AZ
85374-4580
US

IV. Provider business mailing address

15351 W BELL RD
SURPRISE AZ
85374-4580
US

V. Phone/Fax

Practice location:
  • Phone: 877-809-5092
  • Fax:
Mailing address:
  • Phone: 877-809-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number008367
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: