Healthcare Provider Details

I. General information

NPI: 1285472415
Provider Name (Legal Business Name): CAMERON DIEHL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

2020 59TH ST WEST
BRADENTON FL
34209-4604
US

V. Phone/Fax

Practice location:
  • Phone: 859-797-0826
  • Fax:
Mailing address:
  • Phone: 941-290-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: