Provider Demographics
NPI:1720192164
Name:DIAMOND, DAVID J (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11777 BERNARDO PLAZA CT STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2450
Mailing Address - Country:US
Mailing Address - Phone:858-673-2131
Mailing Address - Fax:858-451-3938
Practice Address - Street 1:11777 BERNARDO PLAZA CT STE 108
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2450
Practice Address - Country:US
Practice Address - Phone:858-673-2131
Practice Address - Fax:858-451-3938
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10871103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 10871OtherPHD
CAR14955Medicare UPIN
CACP10871AMedicare ID - Type UnspecifiedMEDICARE