MEDICARE: DR. DIANA LYNN PICKETT MA, MD, PHD

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
1	103TC0700X	Clinical Psychologist	24337	CA

General Provider Information

NPI Number	:	1982983516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA LYNN PICKETT MA, MD, PHD

Provider Business Mailing Address
First Line	:	3932 JEWELL ST
Second Line	:	N202
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-6013
Country	:	US
Telephone Number	:	858-333-1086
Fax Number	:

Provider Business Practice Location Address
First Line	:	3940 HANCOCK ST
Second Line	:	SUITE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5157
Country	:	US
Telephone Number	:	858-246-6069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2011
Last Update Date	:	12/04/2014

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