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General NPI Number Information
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NPI Number | 1417080052
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Entity Type | Individual
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Provider Name | KRISTI JO DIEHL PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 15361 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-7608
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Country | US
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Telephone | 909-393-7171
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Fax | 909-393-7676
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Provider Business Mailing Address
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Address Line | 16441 CYAN CT
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City | CHINO HILLS
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State | CA
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Zip | 91709-4601
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Country | US
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Telephone | 909-393-8082
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Fax | 909-606-9599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA18019
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License Number State | CA
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