Healthcare Provider Details

I. General information

NPI: 1134195084
Provider Name (Legal Business Name): DIANE VU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL SUITE A208
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

2201 MISSION AVE
OCEANSIDE CA
92054
US

V. Phone/Fax

Practice location:
  • Phone: 760-479-3900
  • Fax:
Mailing address:
  • Phone: 760-479-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: