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General NPI Number Information
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NPI Number | 1700978095
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Entity Type | Individual
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Provider Name | DIANE PATRICIA SIEGEL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 10951 CHERRY ST SUITE 201
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2401
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Country | US
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Telephone | 562-799-8553
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Fax |
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Provider Business Mailing Address
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Address Line | 10951 CHERRY ST SUITE 201
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2401
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Country | US
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Telephone | 562-799-8553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY16202
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License Number State | CA
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