Healthcare Provider Details

I. General information

NPI: 1235723347
Provider Name (Legal Business Name): DIANE HOANG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 TELEGRAPH AVE STE 210
OAKLAND CA
94612-1771
US

IV. Provider business mailing address

1272 LORELEI CT
CAMPBELL CA
95008-1716
US

V. Phone/Fax

Practice location:
  • Phone: 510-756-0810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number32411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: