Healthcare Provider Details

I. General information

NPI: 1669665873
Provider Name (Legal Business Name): IRENE DIANE OAXACA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 DALY ST FL 2
LOS ANGELES CA
90031-3309
US

IV. Provider business mailing address

1925 DALY ST. 2ND FLOOR
LOS ANGELES CA
90031-3309
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-4448
  • Fax:
Mailing address:
  • Phone: 323-226-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number264869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: