MEDICARE: DR. DIANA M. ANTONIUCCI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A74113	CA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A74113	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A74113	OTHER	CA	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1164486676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA M. ANTONIUCCI MD

Provider Business Mailing Address
First Line	:	2350 W EL CAMINO REAL FL 2
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-6203
Country	:	US
Telephone Number	:	415-600-0110
Fax Number	:	415-558-7038

Provider Business Practice Location Address
First Line	:	1375 SUTTER ST
Second Line	:	STE 208
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5438
Country	:	US
Telephone Number	:	415-600-0110
Fax Number	:	415-558-7038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	03/20/2019

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