1720109531 NPI number — DR. DIANE CHRISTINE LEROI PH.D.

Table of content: DR. DIANE CHRISTINE LEROI PH.D. (NPI 1720109531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720109531 NPI number — DR. DIANE CHRISTINE LEROI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEROI
Provider First Name:
DIANE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIGHTNER
Provider Other First Name:
DIANE
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720109531
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:
221 N SAN MATEO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94401-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-340-1651
Provider Business Mailing Address Fax Number:
650-348-7888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 N SAN MATEO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94401-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-340-1651
Provider Business Practice Location Address Fax Number:
650-348-7888
Provider Enumeration Date:
04/02/2007

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: 103TC0700X , with the licence number:  PSY9119 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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