Provider Demographics
NPI:1164486676
Name:ANTONIUCCI, DIANA M (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:ANTONIUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:415-600-0110
Mailing Address - Fax:415-558-7038
Practice Address - Street 1:1375 SUTTER ST
Practice Address - Street 2:STE 208
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5438
Practice Address - Country:US
Practice Address - Phone:415-600-0110
Practice Address - Fax:415-558-7038
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74113207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A7411300Medicaid
CAA74113OtherSTATE MEDICAL LICENSE
CA0A7411300Medicare PIN