MEDICARE: DIAMOND NICOLE NEAL HOME HEATH CARE

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	253Z00000X	In Home Supportive Care Agency	002366600	CA
2	376K00000X	Nurse's Aide	00888132	CA

General Provider Information

NPI Number	:	1760277768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAMOND NICOLE NEAL HOME HEATH CARE

Provider Business Mailing Address
First Line	:	2609 S MANSFIELD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3560
Country	:	US
Telephone Number	:	323-690-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 S MANSFIELD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3560
Country	:	US
Telephone Number	:	323-690-9359
Fax Number	:

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

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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