Healthcare Provider Details

I. General information

NPI: 1356272330
Provider Name (Legal Business Name): MICHELLE A DIASPARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NIBLICK RD
PASO ROBLES CA
93446-3409
US

IV. Provider business mailing address

9329 BOCINA LN APT G
ATASCADERO CA
93422-6865
US

V. Phone/Fax

Practice location:
  • Phone: 805-769-1500
  • Fax:
Mailing address:
  • Phone: 516-551-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number210165642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: