Healthcare Provider Details

I. General information

NPI: 1821124355
Provider Name (Legal Business Name): DIANNE RHONDA LYLES RNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD
OAKLAND CA
94605-2409
US

IV. Provider business mailing address

3453 BIRDSALL AVE
OAKLAND CA
94619-2620
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5728
  • Fax: 510-567-5735
Mailing address:
  • Phone: 510-533-5430
  • Fax: 510-533-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number227089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: