MEDICARE: DIANNA KATTENGELL O.D.

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	152W00000X	Optometrist	15038	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15038	OTHER	CA	CALIFORNIA STATE BOARD OF OPTOMETRY

General Provider Information

NPI Number	:	1861800724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNA KATTENGELL O.D.

Provider Business Mailing Address
First Line	:	2011 ARGYLE AVE APT 11
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-3335
Country	:	US
Telephone Number	:	210-365-4744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1431 7TH ST STE 101
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2638
Country	:	US
Telephone Number	:	310-395-5550
Fax Number	:

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	05/09/2023

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