Healthcare Provider Details

I. General information

NPI: 1023217577
Provider Name (Legal Business Name): DIANA DAVIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2007
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W AVENUE L
LANCASTER CA
93534-7211
US

IV. Provider business mailing address

615 W AVENUE L
LANCASTER CA
93534-7211
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-2866
  • Fax:
Mailing address:
  • Phone: 661-723-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA107611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: