MEDICARE: JOSHUA DEIGNAN PHD

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	207SG0203X	Clinical Molecular Genetics Physician	DRN65	CA

General Provider Information

NPI Number	:	1568860120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA DEIGNAN PHD

Provider Business Mailing Address
First Line	:	10833 LE CONTE AVE
Second Line	:	REED 3155
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-3075
Country	:	US
Telephone Number	:	310-825-5264
Fax Number	:

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE
Second Line	:	REED 3155
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-3075
Country	:	US
Telephone Number	:	310-825-5264
Fax Number	:

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

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	12/15/2014

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