MEDICARE: MISS DIVA CHRISTY LUGATIMAN FNP-BC

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	163W00000X	Registered Nurse	757605	CA
2	363LF0000X	Family Nurse Practitioner	757605	CA

General Provider Information

NPI Number	:	1609435940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DIVA CHRISTY LUGATIMAN FNP-BC

Provider Business Mailing Address
First Line	:	437 S EMPIRE ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-2430
Country	:	US
Telephone Number	:	714-309-3403
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 VINE ST STE 221
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5250
Country	:	US
Telephone Number	:	213-943-2490
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	02/05/2025

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