Healthcare Provider Details

I. General information

NPI: 1508337791
Provider Name (Legal Business Name): DIANA K MAI RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

IV. Provider business mailing address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

V. Phone/Fax

Practice location:
  • Phone: 323-857-2000
  • Fax:
Mailing address:
  • Phone: 323-857-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number37499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: