Provider Demographics
NPI:1225139264
Name:MOSBACHER, DIANE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MOSBACHER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1839
Mailing Address - Country:US
Mailing Address - Phone:415-921-5687
Mailing Address - Fax:
Practice Address - Street 1:3570 CLAY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1839
Practice Address - Country:US
Practice Address - Phone:415-921-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2019-05-22
Deactivation Date:2017-08-25
Deactivation Code:
Reactivation Date:2019-05-22
Provider Licenses
StateLicense IDTaxonomies
CAC41542103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist