Healthcare Provider Details

I. General information

NPI: 1649196908
Provider Name (Legal Business Name): DIANA PESQUEIRA APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 E BROKAW RD STE 150
SAN JOSE CA
95112-4221
US

IV. Provider business mailing address

97 E BROKAW RD STE 150
SAN JOSE CA
95112-4221
US

V. Phone/Fax

Practice location:
  • Phone: 408-726-1849
  • Fax: 669-231-8198
Mailing address:
  • Phone: 408-726-1849
  • Fax: 669-231-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC22256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: