MEDICARE: JEAN DIESTO NP

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	363LF0000X	Family Nurse Practitioner	NP95006875	CA

General Provider Information

NPI Number	:	1770009045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN DIESTO NP

Provider Business Mailing Address
First Line	:	1711 W TEMPLE ST STE 3600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7338
Country	:	US
Telephone Number	:	626-354-4743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 W TEMPLE ST STE 3600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7338
Country	:	US
Telephone Number	:	213-989-0700
Fax Number	:

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

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	11/16/2023

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Directions to “ JEAN DIESTO NP” Practice Location

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