Individual
DIBA IZADYAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 SAN BERNARDINO RD STE 1100, UPLAND, CA 91786-4952
(909) 949-2242
(909) 981-5783
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
57199
CA
Other
Enumeration date
10/23/2019
Last updated
04/20/2022
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