Provider Demographics
NPI:1902286735
Name:OLIVER, DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 BRIDGEPOINTE PKWY APT 232
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-5005
Mailing Address - Country:US
Mailing Address - Phone:650-906-1544
Mailing Address - Fax:
Practice Address - Street 1:1927 BRIDGEPOINTE PKWY APT 232
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-5005
Practice Address - Country:US
Practice Address - Phone:650-906-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-06
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75969207R00000X
MA70499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine