MEDICARE: MRS. DIANA MARIA RADAKOVIC 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95003702	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-4076	HI

General Provider Information

NPI Number	:	1891877387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA MARIA RADAKOVIC NP

Provider Business Mailing Address
First Line	:	1849 AVENIDA APRENDA
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-1213
Country	:	US
Telephone Number	:	310-940-5205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 H ST STE 25A
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-5134
Country	:	US
Telephone Number	:	661-310-3688
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/20/2026

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