Active NPI
Diana Maria Clark
- Marriage & Family Therapist
- Tustin, CA
National Provider Identifier
1891986741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 81829
- Practice address
- 18002 Irvine Blvd Ste 202F
Tustin, CA 92780-3322 - Phone
- (657) 205-6611
- NPI assigned
- Aug 6, 2007
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 81829 | CA | Primary |
Addresses
Primary practice location
18002 Irvine Blvd Ste 202F
Tustin, CA 92780-3322
Mailing address
18002 Irvine Blvd Ste 202F
Tustin, CA 92780-3322
Phone (714) 331-8477
Other names 1
- Mrs. Diana Maria Macedo
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724112000000",
"number": "1891986741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18002 IRVINE BLVD STE 202F",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803322",
"telephone_number": "714-331-8477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18002 IRVINE BLVD STE 202F",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803322",
"telephone_number": "657-205-6611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DIANA",
"middle_name": "MARIA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-06",
"last_updated": "2024-08-20",
"certification_date": "2024-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "81829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DIANA",
"last_name": "MACEDO",
"middle_name": "MARIA",
"prefix": "MRS.",
"credential": "LMFT M.S",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.