1235335951 NPI number — DR. DIANE CAROLE PETRONI PHD MFT

Table of content: DR. DIANE CAROLE PETRONI PHD MFT (NPI 1235335951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235335951 NPI number — DR. DIANE CAROLE PETRONI PHD MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETRONI
Provider First Name:
DIANE
Provider Middle Name:
CAROLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETRONI NEWHOUSE
Provider Other First Name:
DIANE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235335951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4990 SPEAK LANE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95118-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-266-7826
Provider Business Mailing Address Fax Number:
408-267-9649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4990 SPEAK LANE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95118-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-266-7826
Provider Business Practice Location Address Fax Number:
408-267-9649
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TP0814X , with the licence number:  MFC17004 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: MFC17004 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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