Alexandra Pauline Diddams, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY31951 Issued in CA

Practice address

1303 San Carlos Ave
San Carlos, CA 94070-2317

Phone

(650) 439-0620

NPI assigned

Jan 20, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1295325652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 FAIRBROOK DR",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404459",
            "telephone_number": "650-804-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 SAN CARLOS AVE",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940702317",
            "telephone_number": "650-439-0620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "851 Fremont Ave Ste 99",
            "address_purpose": "LOCATION",
            "city": "Los Altos",
            "state": "CA",
            "postal_code": "940245602",
            "country_code": "US",
            "telephone_number": "650-439-0620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIDDAMS",
        "first_name": "ALEXANDRA",
        "middle_name": "PAULINE",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY31951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Deorsey
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• Jennifer Dijoseph

• Clinical Psychologist in San Carlos, CA
• Providers in San Carlos, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.