Basic Information
| Provider Information | |||||||||
| NPI: | 1962454652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIEP | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | TRI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 W CHILDS AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093831848 | ||||||||
| FaxNumber: | 2093843966 | ||||||||
| Practice Location | |||||||||
| Address1: | 2760 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CERES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953073235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095565011 | ||||||||
| FaxNumber: | 2095565095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 12/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A91505 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BD9338155 | 01 | CA | DEA CERT | OTHER | A91505 | 01 | CA | MEDICAL LICENSE | OTHER |