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NPI Code Detail

MEDICARE: FANNY DIEPPA

MEDICARE: FANNY DIEPPA
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
1174400000XSpecialistDATA ENTRYCA
2101Y00000XCounselor
3171M00000XCase Manager/Care Coordinator
4225400000XRehabilitation Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PSIX455OTHERCAPROVIDER NUMBER
2C014257OTHERCAIS ACCESS NUMBER

General Provider Information

NPI Number : 1205954989
Entity Type Code : Individual
Provider Name (Legal Business Name) : FANNY DIEPPA
Provider Business Mailing Address
First Line : 12099 W WASHINGTON BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-2622
Country : US
Telephone Number : 301-751-1173
Fax Number :
Provider Business Practice Location Address
First Line : 12099 W WASHINGTON BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-2622
Country : US
Telephone Number : 301-751-1173
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 09/24/2013

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Directions to “ FANNY DIEPPA ” Practice Location

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