Healthcare Provider Details

I. General information

NPI: 1346251055
Provider Name (Legal Business Name): RONALD JOHN DIASO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29369 AUBERRY RD STE 101
PRATHER CA
93651-9784
US

IV. Provider business mailing address

4070 WEST ST
CAMBRIA CA
93428-3023
US

V. Phone/Fax

Practice location:
  • Phone: 559-855-8445
  • Fax: 559-855-8440
Mailing address:
  • Phone: 559-855-8445
  • Fax: 559-855-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number17464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: