Healthcare Provider Details

I. General information

NPI: 1124654116
Provider Name (Legal Business Name): DIANE MARIE LIBERT BS, MPHIL, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 E GRAND AVE STE A
SOUTH SAN FRANCISCO CA
94080-6234
US

IV. Provider business mailing address

383 E GRAND AVE STE A
SOUTH SAN FRANCISCO CA
94080-6234
US

V. Phone/Fax

Practice location:
  • Phone: 650-616-2951
  • Fax:
Mailing address:
  • Phone: 650-616-2951
  • Fax: 650-737-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA184273
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA184273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: