Provider Demographics
NPI:1386689453
Name:DIEGO, LORAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORAINE
Middle Name:
Last Name:DIEGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 W 8TH ST
Mailing Address - Street 2:SUITE #105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5016
Mailing Address - Country:US
Mailing Address - Phone:213-388-2229
Mailing Address - Fax:213-388-1507
Practice Address - Street 1:2405 W 8TH ST
Practice Address - Street 2:SUITE #105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5016
Practice Address - Country:US
Practice Address - Phone:213-388-2229
Practice Address - Fax:213-388-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67445207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH40468Medicare UPIN