Healthcare Provider Details

I. General information

NPI: 1922460914
Provider Name (Legal Business Name): DIANA HUIZAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 SCENIC DR
MODESTO CA
95350-6137
US

IV. Provider business mailing address

1224 SCENIC DR
MODESTO CA
95350-6137
US

V. Phone/Fax

Practice location:
  • Phone: 209-658-2282
  • Fax: 833-573-2336
Mailing address:
  • Phone:
  • Fax: 833-573-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number684594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: