Provider Demographics
NPI:1659506384
Name:GUEST, DIANA L (MFT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:GUEST
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 1:1767 GRAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4400
Mailing Address - Country:US
Mailing Address - Phone:858-274-1662
Mailing Address - Fax:858-273-9410
Practice Address - Street 1:1767 GRAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4400
Practice Address - Country:US
Practice Address - Phone:858-274-1662
Practice Address - Fax:858-273-9410
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist