MEDICARE: DR. DIANA SUPERFIN M.D.

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	207RH0003X	Hematology & Oncology Physician	A84532	CA

General Provider Information

NPI Number	:	1750365953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA SUPERFIN M.D.

Provider Business Mailing Address
First Line	:	500 LENNON LN
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-2415
Country	:	US
Telephone Number	:	925-939-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 LENNON LN
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-2415
Country	:	US
Telephone Number	:	925-939-9610
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	09/23/2009

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