Healthcare Provider Details

I. General information

NPI: 1407132442
Provider Name (Legal Business Name): GARY H. DIEP RN, CNOR, RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28062 BAXTER RD
MURRIETA CA
92563-1401
US

IV. Provider business mailing address

23997 COLMAR LN
MURRIETA CA
92562-1977
US

V. Phone/Fax

Practice location:
  • Phone: 951-290-4000
  • Fax:
Mailing address:
  • Phone: 626-202-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number637910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: