Provider Demographics
NPI:1710987425
Name:COOPER-BYRAM, DIANNE OSHINSKY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:OSHINSKY
Last Name:COOPER-BYRAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:280 CAGNEY LN
Mailing Address - Street 2:APT 119
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2677
Mailing Address - Country:US
Mailing Address - Phone:805-658-0475
Mailing Address - Fax:805-985-0872
Practice Address - Street 1:1400 QUAIL ST
Practice Address - Street 2:STE 250
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2714
Practice Address - Country:US
Practice Address - Phone:805-658-0475
Practice Address - Fax:805-985-0872
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15836103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15836Medicare ID - Type UnspecifiedPROVIDER #