Healthcare Provider Details

I. General information

NPI: 1154257103
Provider Name (Legal Business Name): DIANA LYNN M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 S ABBOTT AVE
MILPITAS CA
95035-5256
US

IV. Provider business mailing address

2181 N TRACY BLVD
TRACY CA
95376-2424
US

V. Phone/Fax

Practice location:
  • Phone: 408-945-0600
  • Fax: 408-945-0601
Mailing address:
  • Phone: 408-945-0600
  • Fax: 408-945-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: