Active NPI
Diana L Wertz, M.D., PH.D.
- Psychiatry Physician
- San Mateo, CA
National Provider Identifier
1205147113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A119989
- Practice address
- 1700 S Amphlett Blvd
Suite 250F
San Mateo, CA 94402-2701 - Phone
- (650) 690-2778
- Fax
- (844) 864-1701
- NPI assigned
- Jun 24, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A119989 | CA | Primary |
Addresses
Primary practice location
1700 S Amphlett Blvd
Suite 250F
San Mateo, CA 94402-2701
Mailing address
1630 S Delaware St
PO Box 25572
San Mateo, CA 94402-6600
Phone (650) 690-2778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119989 | CA | MD | Clinical Social Worker |
| A119989 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439251200000",
"number": "1205147113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1630 S DELAWARE ST",
"address_2": "PO BOX 25572",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944026600",
"telephone_number": "650-690-2778",
"fax_number": "844-864-1701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 S AMPHLETT BLVD",
"address_2": "SUITE 250F",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944022701",
"telephone_number": "650-690-2778",
"fax_number": "844-864-1701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WERTZ",
"first_name": "DIANA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D., PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-24",
"last_updated": "2015-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A119989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.