MEDICARE: DIANE DINIZ RDH

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	124Q00000X	Dental Hygienist	17395	CA
2	174400000X	Specialist	17395	CA

General Provider Information

NPI Number	:	1427636521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE DINIZ RDH

Provider Business Mailing Address
First Line	:	3152 FOREST LAKE RD
Second Line	:
City	:	PEBBLE BEACH
State	:	CA
Zip	:	93953-3200
Country	:	US
Telephone Number	:	831-238-6471
Fax Number	:

Provider Business Practice Location Address
First Line	:	3152 FOREST LAKE RD
Second Line	:
City	:	PEBBLE BEACH
State	:	CA
Zip	:	93953-3200
Country	:	US
Telephone Number	:	831-238-6471
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/30/2021

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