Healthcare Provider Details

I. General information

NPI: 1952493413
Provider Name (Legal Business Name): MARY JANE DIOGO RN, NP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 30TH ST SUITE 205
OAKLAND CA
94609-3424
US

IV. Provider business mailing address

350 30TH ST SUITE 205
OAKLAND CA
94609-3424
US

V. Phone/Fax

Practice location:
  • Phone: 510-271-5339
  • Fax:
Mailing address:
  • Phone: 510-271-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN320362
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 5855
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM1359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: