Provider Demographics
NPI:1518178979
Name:PAK, DIANA I (PH D)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:I
Last Name:PAK
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 N COOPER RD
Mailing Address - Street 2:#85
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5892
Mailing Address - Country:US
Mailing Address - Phone:602-573-5813
Mailing Address - Fax:
Practice Address - Street 1:97 N COOPER RD
Practice Address - Street 2:#85
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5892
Practice Address - Country:US
Practice Address - Phone:602-573-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2048493103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool