Healthcare Provider Details

I. General information

NPI: 1760277768
Provider Name (Legal Business Name): DIAMOND NICOLE NEAL HOME HEATH CARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 S MANSFIELD AVE
LOS ANGELES CA
90016-3560
US

IV. Provider business mailing address

2609 S MANSFIELD AVE
LOS ANGELES CA
90016-3560
US

V. Phone/Fax

Practice location:
  • Phone: 323-690-9359
  • Fax:
Mailing address:
  • Phone: 323-690-9359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00888132
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number002366600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: