Healthcare Provider Details

I. General information

NPI: 1295122562
Provider Name (Legal Business Name): DRAGOS DIACONESCU MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-0401
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DRAGOS DIACONESCU
Title or Position: PRESIDENT
Credential: MD
Phone: 617-905-8380