Provider Demographics
NPI:1881202760
Name:BIGNONE, DIEGO ANDRES
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:ANDRES
Last Name:BIGNONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27701 PALOS VERDES DR E
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5148
Mailing Address - Country:US
Mailing Address - Phone:310-629-6695
Mailing Address - Fax:
Practice Address - Street 1:1218 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4718
Practice Address - Country:US
Practice Address - Phone:310-545-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor