Individual
MS. DIANE MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
501 S IDAHO ST STE 250, LA HABRA, CA 90631-6594
(562) 690-0400
(562) 690-3182
Mailing address
501 S IDAHO ST, STE 100, LA HABRA, CA 90631-6047
(562) 690-0400
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
961
KS
103TC0700X
Clinical Psychologist
PY01796
MO
1041C0700X
Clinical Social Worker
SW001771
MO
363A00000X
Physician Assistant
15-01466
KS
363A00000X
Physician Assistant
Primary
PA54144
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100212200B
—
KS
Enumeration date
04/19/2007
Last updated
01/28/2025
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