Healthcare Provider Details

I. General information

NPI: 1447657804
Provider Name (Legal Business Name): DIANA LOLA PADDOCK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA LOLA KIRCHMANN

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 ENCINITAS BLVD
ENCINITAS CA
92024-2933
US

IV. Provider business mailing address

FILE 57326
LOS ANGELES CA
90074-7326
US

V. Phone/Fax

Practice location:
  • Phone: 800-926-8273
  • Fax: 888-539-8781
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA52175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: