Provider Demographics
NPI:1619482098
Name:NOVIN, DIANNE BRIGETTE (NP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:BRIGETTE
Last Name:NOVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:BRIGETTE
Other - Last Name:LLORICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2208 MARSHALLFIELD LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5016
Mailing Address - Country:US
Mailing Address - Phone:661-487-9113
Mailing Address - Fax:
Practice Address - Street 1:5525 ETIWANDA AVE STE 211
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6136
Practice Address - Country:US
Practice Address - Phone:818-757-1212
Practice Address - Fax:818-757-1311
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95008038OtherNURSE PRACTITIONER FURNISHING NUMBER