MEDICARE: DR. STEPHEN A. DIAMOND PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY11404	CA

General Provider Information

NPI Number	:	1275639213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN A. DIAMOND PH.D.

Provider Business Mailing Address
First Line	:	6535 WILSHIRE BLVD STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4962
Country	:	US
Telephone Number	:	323-651-1118
Fax Number	:

Provider Business Practice Location Address
First Line	:	6535 WILSHIRE BLVD STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4962
Country	:	US
Telephone Number	:	323-651-1118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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