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General NPI Number Information
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NPI Number | 1578052916
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Entity Type | Individual
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Provider Name | KATY DIBENE
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Gender | Female
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 2101 ROSECRANS AVE # 3230
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City | EL SEGUNDO
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State | CA
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Zip | 90245-4749
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Country | US
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Telephone | 323-628-8671
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Fax |
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Provider Business Mailing Address
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Address Line | 309 E 2ND ST
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City | POMONA
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State | CA
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Zip | 91766-1854
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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 |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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