Healthcare Provider Details

I. General information

NPI: 1497888614
Provider Name (Legal Business Name): DIANA FRANCES SAYLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 E. BLITHEDALE AVE SUITE #A
MILL VALLEY CA
94941
US

IV. Provider business mailing address

619 E. BLITHEDALE AVE SUITE #A
MILL VALLEY CA
94941
US

V. Phone/Fax

Practice location:
  • Phone: 415-388-2801
  • Fax: 415-388-2803
Mailing address:
  • Phone: 415-388-2801
  • Fax: 415-388-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19543
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1499
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: