Provider Demographics
NPI:1639799034
Name:WEGBREIT, DIANA TORREY (MFT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:TORREY
Last Name:WEGBREIT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 SAN CLEMENTE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3121
Mailing Address - Country:US
Mailing Address - Phone:650-380-2636
Mailing Address - Fax:
Practice Address - Street 1:760 SAN CLEMENTE WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-3121
Practice Address - Country:US
Practice Address - Phone:650-380-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT44606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist