Healthcare Provider Details

I. General information

NPI: 1043078900
Provider Name (Legal Business Name): DIANA JOAN MUNRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 205
NEWPORT BEACH CA
92663-3667
US

IV. Provider business mailing address

520 SUPERIOR AVE STE 205
NEWPORT BEACH CA
92663-3667
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-1843
  • Fax:
Mailing address:
  • Phone: 949-764-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95028818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: