Diane Park MD LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

32107 Issued in AZ

Legal business name

DIANE PARK MD LLC

Practice address

1845 S Dobson Rd
Suite 109
Mesa, AZ 85202-5661

Phone

(480) 204-2477

NPI assigned

Nov 15, 2012

Organization subpart

No

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

Authorized official

Name

Diane Park, MD

Title

Owner

Phone

(480) 204-2477

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Kay Bradley, PSY.D.

  • Clinical Psychologist
  • Tempe, AZ
  • NPI 1386765550
  NPD (past)
• Kathleen Mary Cramer, PHD

  • Psychologist
  • Mesa, AZ
  • NPI 1811133317
  NPD (past)
• Judith Ellen Rand, PH.D.

  • Clinical Psychologist
  • Mesa, AZ
  • NPI 1609004043
  NPD (past)

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1972847903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 S DOBSON RD",
            "address_2": "SUITE 109",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852025661",
            "telephone_number": "480-204-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 S DOBSON RD",
            "address_2": "SUITE 109",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852025661",
            "telephone_number": "480-204-2477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANE PARK MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-204-2477",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "32107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1609946672",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jaclyn Diaz-Picchi, MC LPC
• Adela Diaz, PA-C
• Cristina Diaz, CNM
• Monica Diaz, REGISTERED DIETICIAN

• Mental Health Counselor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.