Healthcare Provider Details

I. General information

NPI: 1396609962
Provider Name (Legal Business Name): DIANE ORIO GONZAGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SINCLAIR AVE UNIT 219
GLENDALE CA
91206-4018
US

IV. Provider business mailing address

121 SINCLAIR AVE UNIT 219
GLENDALE CA
91206-4018
US

V. Phone/Fax

Practice location:
  • Phone: 818-235-2516
  • Fax:
Mailing address:
  • Phone: 818-235-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP96037741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: