Provider Demographics
NPI:1205267911
Name:ROVELLO FREKING, DIONI ALICIA (ACNP-BC)
Entity type:Individual
Prefix:
First Name:DIONI
Middle Name:ALICIA
Last Name:ROVELLO FREKING
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:DIONI
Other - Middle Name:ALICIA
Other - Last Name:ROVELLO FREKING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:1510 SAN PABLO STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-1241
Mailing Address - Fax:
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-865-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495353363LA2100X
CA11058363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care