MEDICARE: DIANE MONCAYO PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	22510	CA
2	363LP2300X	Primary Care Nurse Practitioner	22510	CA

General Provider Information

NPI Number	:	1114336997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MONCAYO PNP

Provider Business Mailing Address
First Line	:	12826 PHILADELPHIA ST
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4117
Country	:	US
Telephone Number	:	562-789-8208
Fax Number	:

Provider Business Practice Location Address
First Line	:	12826 PHILADELPHIA ST
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4117
Country	:	US
Telephone Number	:	562-789-8208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	04/12/2017

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