Individual
DIANA M BREISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2275 RIO BONITO WAY, SUITE 220, SAN DIEGO, CA 92108-1685
(619) 822-1667
(619) 684-1730
Mailing address
2275 RIO BONITO WAY, SUITE 220, SAN DIEGO, CA 92108-1685
(619) 822-1667
(619) 684-1730
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
A55510
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A555101
—
CA
01
—
1396046454
NPI TYPE 2
—
01
—
A55510
MEDICAL LICENSE
CA
Enumeration date
11/14/2005
Last updated
02/03/2012
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