MEDICARE: DEMIJON LINGAD DICEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	60429	CA

General Provider Information

NPI Number	:	1528726429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMIJON LINGAD DICEN

Provider Business Mailing Address
First Line	:	215 S LA CIENEGA BLVD STE 207
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3322
Country	:	US
Telephone Number	:	310-272-4395
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 S LA CIENEGA BLVD STE 207
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3322
Country	:	US
Telephone Number	:	310-272-4395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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Directions to “ DEMIJON LINGAD DICEN ” Practice Location

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