MEDICARE: SHANNON DIANA ROST

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	246Z00000X	Other Specialist/Technologist		CA

General Provider Information

NPI Number	:	1740131812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DIANA ROST

Provider Business Mailing Address
First Line	:	PO BOX 93313
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90093-0313
Country	:	US
Telephone Number	:	310-220-7914
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 N HIGHLAND AVE
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-7902
Country	:	US
Telephone Number	:	310-220-7914
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ SHANNON DIANA ROST ” Practice Location

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