Healthcare Provider Details

I. General information

NPI: 1356770606
Provider Name (Legal Business Name): DIANE SCHOENDIENST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE STE 1M107
COLTON CA
92324-1801
US

IV. Provider business mailing address

400 N PEPPER AVE STE 1M107
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-2178
  • Fax:
Mailing address:
  • Phone: 909-580-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: