Provider Demographics
NPI:1205147113
Name:WERTZ, DIANA L (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:WERTZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 S DELAWARE ST
Mailing Address - Street 2:PO BOX 25572
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-6600
Mailing Address - Country:US
Mailing Address - Phone:650-690-2778
Mailing Address - Fax:844-864-1701
Practice Address - Street 1:1700 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 250F
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2701
Practice Address - Country:US
Practice Address - Phone:650-690-2778
Practice Address - Fax:844-864-1701
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1199892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry