Provider Demographics
NPI:1962492520
Name:GHIRON, DIANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:GHIRON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 SAN JUAN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1115
Mailing Address - Country:US
Mailing Address - Phone:619-501-4185
Mailing Address - Fax:619-232-7219
Practice Address - Street 1:2270 SAN JUAN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1115
Practice Address - Country:US
Practice Address - Phone:619-501-4185
Practice Address - Fax:619-232-7219
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17333103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical