Healthcare Provider Details

I. General information

NPI: 1528335486
Provider Name (Legal Business Name): DIANE ASMUTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CREEKSIDE DR #3200
FOLSOM CA
95630-3444
US

IV. Provider business mailing address

5709 THAMES WAY
CARMICHAEL CA
95608-5556
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-8868
  • Fax:
Mailing address:
  • Phone: 916-487-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: