Provider Demographics
NPI:1942200571
Name:ROSE-DEYOUNG, DIANNE (RNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:ROSE-DEYOUNG
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 E 7TH ST
Mailing Address - Street 2:ENT CLINIC 112
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:562-826-5558
Mailing Address - Fax:562-826-8119
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:ENT CLINIC 112
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-5558
Practice Address - Fax:562-826-8119
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249417363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health