Healthcare Provider Details

I. General information

NPI: 1861091126
Provider Name (Legal Business Name): SILVIA DIEGO MD INC A PROFESSIONAL MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 OAKDALE RD STE 100
MODESTO CA
95355-3362
US

IV. Provider business mailing address

1317 OAKDALE RD STE 440
MODESTO CA
95355-3364
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-3362
  • Fax: 209-522-3363
Mailing address:
  • Phone: 209-522-3363
  • Fax: 209-522-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SILVIA M DIEGO
Title or Position: OWNER
Credential: MD
Phone: 209-480-9955