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Individual

DR. KENNETH ROBERT DIDDIE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1220 LA VENTA DR, SUITE 211, WESTLAKE VILLAGE, CA 91361-3703
(805) 379-0200
(805) 496-5204
Mailing address
1220 LA VENTA DR, SUITE 211, WESTLAKE VILLAGE, CA 91361-3703
(805) 379-0200
(805) 496-5204

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G033939
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G339391
CA
Enumeration date
03/24/2006
Last updated
03/01/2021
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