Healthcare Provider Details

I. General information

NPI: 1700680022
Provider Name (Legal Business Name): DIANE LUKESBELLECI PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 APPALACHIAN WAY
MARTINEZ CA
94553-6210
US

IV. Provider business mailing address

420 APPALACHIAN WAY
MARTINEZ CA
94553-6210
US

V. Phone/Fax

Practice location:
  • Phone: 559-475-3875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: