Provider Demographics
NPI:1457467490
Name:LI-REPAC, DIANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:LI-REPAC
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 1:632 VARESE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6397
Mailing Address - Country:US
Mailing Address - Phone:925-484-2656
Mailing Address - Fax:925-484-5602
Practice Address - Street 1:5674 STONERIDGE DR
Practice Address - Street 2:SUITE 217
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8500
Practice Address - Country:US
Practice Address - Phone:925-484-5602
Practice Address - Fax:925-734-0704
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8114103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA460514392OtherEIN