Healthcare Provider Details

I. General information

NPI: 1245773670
Provider Name (Legal Business Name): LUPITA DIAZ-NAVARRO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS LUPITA DIAZ

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ STE 530
LOS ANGELES CA
90095-2613
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7922
  • Fax: 310-267-1899
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number4498
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95004602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: