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NPI Code Detail

MEDICARE: DR. DIANE ESCOFFON PH.D.

MEDICARE: DR. DIANE ESCOFFON 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
1103T00000XPsychologistPSY18636CA

General Provider Information

NPI Number : 1831473727
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE ESCOFFON PH.D.
Provider Business Mailing Address
First Line : PO BOX 106
Second Line :
City : JACKSON
State : CA
Zip : 95642-0106
Country : US
Telephone Number : 650-483-8991
Fax Number :
Provider Business Practice Location Address
First Line : 1001 BROADWAY
Second Line :
City : JACKSON
State : CA
Zip : 95642-2649
Country : US
Telephone Number : 209-256-1998
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2011
Last Update Date : 01/09/2012

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Directions to “ DR. DIANE ESCOFFON PH.D.” Practice Location

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