Provider Demographics
NPI:1700628385
Name:DIOSDADO, MARIA GUADALUPE (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GUADALUPE
Last Name:DIOSDADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 S MANCHESTER AVE UNIT 1079
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3240
Mailing Address - Country:US
Mailing Address - Phone:909-223-3340
Mailing Address - Fax:
Practice Address - Street 1:2151 N HARBOR BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3826
Practice Address - Country:US
Practice Address - Phone:714-446-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151509163W00000X, 363L00000X
CA95030067363LF0000X
CA95187676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner