Provider Demographics
NPI:1346481231
Name:WHELAN, DIANE (MPH, RD, LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WHELAN
Suffix:
Gender:F
Credentials:MPH, RD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 FOREST AVE
Mailing Address - Street 2:SUITE C3
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3367
Mailing Address - Country:US
Mailing Address - Phone:310-208-4288
Mailing Address - Fax:
Practice Address - Street 1:311 FOREST AVE
Practice Address - Street 2:SUITE C3
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3367
Practice Address - Country:US
Practice Address - Phone:310-208-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR560271133N00000X, 133NN1002X, 133V00000X, 133VN1006X
CA84398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic