Healthcare Provider Details

I. General information

NPI: 1740196526
Provider Name (Legal Business Name): DYLAN DIGGDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

2756 37TH AVE SW
SEATTLE WA
98126-2109
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-9402
  • Fax:
Mailing address:
  • Phone: 206-673-7317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: