Provider Demographics
NPI:1063764090
Name:DIMARTINI, JOHN ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:DIMARTINI
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 1:5605 OCEAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1532
Mailing Address - Country:US
Mailing Address - Phone:510-658-0990
Mailing Address - Fax:
Practice Address - Street 1:5605 OCEAN VIEW DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1532
Practice Address - Country:US
Practice Address - Phone:510-658-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10872103T00000X
103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis