Provider Demographics
NPI:1033295456
Name:HUISINGA, DIANE J (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:HUISINGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 SUNRISE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4504
Mailing Address - Country:US
Mailing Address - Phone:916-771-7852
Mailing Address - Fax:530-622-2793
Practice Address - Street 1:729 SUNRISE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4504
Practice Address - Country:US
Practice Address - Phone:916-771-7852
Practice Address - Fax:530-622-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL160590Medicare ID - Type UnspecifiedPROVIDER ID#