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NPI Code Detail

MEDICARE: DIANA G TIRA RDHAP

MEDICARE:   DIANA G TIRA  RDHAP
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
1124Q00000XDental Hygienist352CA

General Provider Information

NPI Number : 1215214796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA G TIRA RDHAP
Provider Business Mailing Address
First Line : 4467 AVENIDA DE LAS FLORES
Second Line :
City : YORBA LINDA
State : CA
Zip : 92886-2952
Country : US
Telephone Number : 714-779-9171
Fax Number :
Provider Business Practice Location Address
First Line : 4467 AVENIDA DE LAS FLORES
Second Line :
City : YORBA LINDA
State : CA
Zip : 92886-2952
Country : US
Telephone Number : 714-779-9171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2011
Last Update Date : 11/10/2011

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Directions to “ DIANA G TIRA RDHAP” Practice Location

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