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General NPI Number Information
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NPI Number | 1417372426
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Entity Type | Individual
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Provider Name | MRS. LEILANI FANG DIEGO
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Gender | Female
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 1326 W CARSON ST APT 112
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City | TORRANCE
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State | CA
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Zip | 90501-6500
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Country | US
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Telephone | 562-787-1655
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 PACIFIC COAST HWY STE S
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City | LOMITA
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State | CA
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Zip | 90717-2660
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Country | US
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Telephone | 562-787-1655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23159
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License Number State | CA
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