Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY20847 | CA |
Y | 103T00000X | Psychologist | PSY20847 | CA |
NPI | 1013036599 |
---|---|
Provider Name | Dr. Diane Marie Dumas |
First Address | San Marcus, CA 92069-7393 |
Second Address | San Marcus, CA 92069-7393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |