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General NPI Number Information
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NPI Number | 1831427293
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Entity Type | Individual
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Provider Name | DIANE PUCHBAUER PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 188 N EUCLID AVE
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City | UPLAND
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State | CA
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Zip | 91786-6083
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Country | US
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Telephone | 562-547-0137
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Fax | 909-921-0221
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Provider Business Mailing Address
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Address Line | PO BOX 1570
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City | UPLAND
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State | CA
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Zip | 91785-1570
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Country | US
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Telephone | 562-547-0137
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Fax | 909-921-0221
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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 | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PSY21870
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 21870
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License Number State | CA
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