Healthcare Provider Details

I. General information

NPI: 1609881374
Provider Name (Legal Business Name): DIANA V. MESSADI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE #A0-125CHS
LOS ANGELES CA
90095-1668
US

IV. Provider business mailing address

10833 LE CONTE AVE # A0125CHS
LOS ANGELES CA
90095-1668
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8879
  • Fax: 310-825-2124
Mailing address:
  • Phone: 310-825-8879
  • Fax: 310-825-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: