Individual provider Active NPI

Dianne Marie David, P.A.

  • Medical Physician Assistant
  • Modesto, CA
National Provider Identifier
1356500037
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA15572 Issued in CA
Practice address
1552 Coffee Rd Ste 200
Modesto, CA 95355-3122
Phone
(209) 248-7168
Fax
(209) 846-9641
NPI assigned
Jun 6, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA15572 CA Primary

Addresses

Primary practice location

1552 Coffee Rd Ste 200
Modesto, CA 95355-3122

Mailing address

1552 Coffee Rd Ste 200
Modesto, CA 95355-3122
Phone (209) 248-7168

Other identifiers 1

IdentifierTypeStateIssuer
PA15572OtherCAPAC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15572CAMDSpeech-Language Pathologist
PA15572CAMDMedical Physician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1356500037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1552 COFFEE RD STE 200",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953553122",
            "telephone_number": "209-248-7168",
            "fax_number": "209-846-9641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1552 COFFEE RD STE 200",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953553122",
            "telephone_number": "209-248-7168",
            "fax_number": "209-846-9641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVID",
        "first_name": "DIANNE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA15572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAC",
            "identifier": "PA15572",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.