Healthcare Provider Details

I. General information

NPI: 1164751053
Provider Name (Legal Business Name): MERCIE JOSINA DIGANGI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE ROOM 112
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2020 ZONAL AVE ROOM 112
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-3688
  • Fax:
Mailing address:
  • Phone: 323-226-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A11036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: