Healthcare Provider Details

I. General information

NPI: 1164486676
Provider Name (Legal Business Name): DIANA M. ANTONIUCCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 SUTTER ST STE 208
SAN FRANCISCO CA
94109-5438
US

IV. Provider business mailing address

2350 W EL CAMINO REAL FL 2
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-0110
  • Fax: 415-558-7038
Mailing address:
  • Phone: 415-600-0110
  • Fax: 415-558-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA74113
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA74113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: