Individual
DR. DIRK ROSS DIEFENDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 S ELLSWORTH AVE, SUITE 607, SAN MATEO, CA 94401-3956
(650) 347-0157
(650) 347-0566
Mailing address
101 S ELLSWORTH AVE, SUITE 607, SAN MATEO, CA 94401-3956
(650) 347-0157
(650) 347-0566
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
G53558
CA
Other
Enumeration date
09/20/2006
Last updated
08/30/2010
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