Healthcare Provider Details

I. General information

NPI: 1528406527
Provider Name (Legal Business Name): MOLLY MAXINE DIAZ KANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY MAXINE DIAZ

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 08/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 DUBLIN BVLD
DUBLIN CA
94568
US

IV. Provider business mailing address

4050 DUBLIN BLVD FL 1
DUBLIN CA
94568-3112
US

V. Phone/Fax

Practice location:
  • Phone: 925-875-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125063627
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC177158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: