Healthcare Provider Details

I. General information

NPI: 1467635466
Provider Name (Legal Business Name): RONALD C. DIEBEL, M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 OCONNOR DR SUITE 1
SAN JOSE CA
95128-1656
US

IV. Provider business mailing address

1101 S WINCHESTER BLVD. STE. D-146
SAN JOSE CA
95128-3915
US

V. Phone/Fax

Practice location:
  • Phone: 408-314-5000
  • Fax:
Mailing address:
  • Phone: 408-314-5000
  • Fax: 408-287-7847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberG19786
License Number StateCA

VIII. Authorized Official

Name: RONALD C DIEBEL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 408-314-5000