Healthcare Provider Details

I. General information

NPI: 1316647027
Provider Name (Legal Business Name): NATALIA DIAVATIS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 HILLCREST AVE
ANTIOCH CA
94531-8238
US

IV. Provider business mailing address

164 ROBLES WAY # 129
VALLEJO CA
94591-8039
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-6300
  • Fax:
Mailing address:
  • Phone: 925-263-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY34047
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34047
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: