Healthcare Provider Details

I. General information

NPI: 1962345264
Provider Name (Legal Business Name): DIEGO TOMMASO THOMPSON MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 53
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

117 E NORTHERN PKWY
BALTIMORE MD
21212-2902
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3849
  • Fax:
Mailing address:
  • Phone: 443-520-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: