MEDICARE: DR. DIANE JOAN SOMMERS 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	103T00000X	Psychologist	PSY15374	CA

General Provider Information

NPI Number	:	1801940994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE JOAN SOMMERS PH.D.

Provider Business Mailing Address
First Line	:	25665 COUNTY ROAD 99
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-9504
Country	:	US
Telephone Number	:	530-756-7757
Fax Number	:	530-756-4896

Provider Business Practice Location Address
First Line	:	1260 LAKE BLVD
Second Line	:	SUITE 217
City	:	DAVIS
State	:	CA
Zip	:	95616-2614
Country	:	US
Telephone Number	:	530-297-7757
Fax Number	:	530-756-4896

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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