Basic Information
Provider Information
NPI: 1215391750
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPEECHLEY
FirstName: DIANE
MiddleName: MARIA SCHNEIDER
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 DISTEL CIR
Address2:  
City: LOS ALTOS
State: CA
PostalCode: 940221408
CountryCode: US
TelephoneNumber: 5102043977
FaxNumber: 5102045429
Practice Location
Address1: 2450 ASHBY AVE RM 3040
Address2:  
City: BERKELEY
State: CA
PostalCode: 947052067
CountryCode: US
TelephoneNumber: 5102043977
FaxNumber: 5102045129
Other Information
ProviderEnumerationDate: 04/11/2016
LastUpdateDate: 07/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XA152664CAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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