Healthcare Provider Details

I. General information

NPI: 1518678531
Provider Name (Legal Business Name): DIANA LEIGH HASENPFLUG ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 SANTA RITA RD
PLEASANTON CA
94566-6176
US

IV. Provider business mailing address

10744 DULSIE LN
DUBLIN CA
94568-5535
US

V. Phone/Fax

Practice location:
  • Phone: 925-895-9244
  • Fax:
Mailing address:
  • Phone: 925-895-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number951079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: