MEDICARE: DIANE G. RODGERS

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	164X00000X	Licensed Vocational Nurse	VN136422	CA

General Provider Information

NPI Number	:	1760662845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE G. RODGERS

Provider Business Mailing Address
First Line	:	4124 DON FELIPE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4124 DON FELIPE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4207
Country	:	US
Telephone Number	:	626-795-7218
Fax Number	:	626-796-1298

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

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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