=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003056631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA GABRIELA DI RIENZO MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2009
-----------------------------------------------------
Last Update Date | 02/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1460 MARIA LANE STE 310
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-937-9707
-----------------------------------------------------
Fax | 925-299-1928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 623
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94549-0623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-937-9707
-----------------------------------------------------
Fax | 925-299-1928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC43595
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------