Active NPI
Diane Redmon, MFT INTERN
- Marriage & Family Therapist
- Stockton, CA
National Provider Identifier
1336366632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 52739
- Practice address
- 2495 W March LN
Suite 125
Stockton, CA 95207-8251 - Phone
- (209) 645-1080
- Fax
- (209) 465-2709
- NPI assigned
- Apr 19, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 52739 | CA | Primary |
Addresses
Primary practice location
2495 W March LN
Suite 125
Stockton, CA 95207-8251
Mailing address
1736 De Ovan Ave
Stockton, CA 95204-1712
Phone (209) 648-6635
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52739 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336366632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1736 DE OVAN AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952041712",
"telephone_number": "209-648-6635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2495 W MARCH LN",
"address_2": "SUITE 125",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952078251",
"telephone_number": "209-645-1080",
"fax_number": "209-465-2709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDMON",
"first_name": "DIANE",
"name_prefix": "Ms.",
"credential": "MFT INTERN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "52739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.