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General NPI Number Information
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NPI Number | 1225217441
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Entity Type | Organization
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Legal Business Name | LORAINE V. DIEGO, M.D.
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 2405 W 8TH ST STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90057-5016
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Country | US
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Telephone | 213-388-2232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27206
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City | LOS ANGELES
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State | CA
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Zip | 90027-0206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORAINE DIEGO
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Credential |
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Telephone | 213-388-2232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A67445
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License Number State | CA
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