Healthcare Provider Details

I. General information

NPI: 1225336308
Provider Name (Legal Business Name): DIANA OGALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD SUITE 100
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

2755 RAYMOND AVE APT #2
LOS ANGELES CA
90007-2125
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7464
  • Fax:
Mailing address:
  • Phone: 323-632-4276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: