Healthcare Provider Details

I. General information

NPI: 1730944133
Provider Name (Legal Business Name): DESIREE JEAN DILORENZO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 SANTA MONICA BLVD STE 304
LOS ANGELES CA
90025-6931
US

IV. Provider business mailing address

1821 PACIFIC COAST HWY APT 24
HERMOSA BEACH CA
90254-3132
US

V. Phone/Fax

Practice location:
  • Phone: 310-470-2909
  • Fax:
Mailing address:
  • Phone: 818-744-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC36891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: