Healthcare Provider Details

I. General information

NPI: 1750039699
Provider Name (Legal Business Name): DIANA HOANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 WATT AVE
NORTH HIGHLANDS CA
95660-4752
US

IV. Provider business mailing address

5700 WATT AVE
NORTH HIGHLANDS CA
95660-4752
US

V. Phone/Fax

Practice location:
  • Phone: 916-332-5715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: