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NPI Code Detail

MEDICARE: DR. DIANA MEDINA PH.D.

MEDICARE: DR. DIANA MEDINA PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY-004607AZ
2103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1760886121
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA MEDINA PH.D.
Provider Business Mailing Address
First Line : PO BOX 50384
Second Line :
City : PHOENIX
State : AZ
Zip : 85076-0384
Country : US
Telephone Number : 602-796-7081
Fax Number :
Provider Business Practice Location Address
First Line : 16220 N SCOTTSDALE RD STE 300
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85254-1798
Country : US
Telephone Number : 480-328-8464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2014
Last Update Date : 10/14/2024

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