Provider Demographics
NPI:1780785220
Name:DIAKIW, ADRIANA (MD)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:DIAKIW
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 1:1370 ROSECRANS ST
Mailing Address - Street 2:STE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2638
Mailing Address - Country:US
Mailing Address - Phone:619-225-0602
Mailing Address - Fax:619-225-0604
Practice Address - Street 1:1370 ROSECRANS ST
Practice Address - Street 2:STE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2638
Practice Address - Country:US
Practice Address - Phone:619-225-0602
Practice Address - Fax:619-225-0604
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA78897OtherCA. MEDICAL LICENSE
CAI38698Medicare UPIN