Individual
FANNY DIEPPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12099 W WASHINGTON BLVD STE 200, LOS ANGELES, CA 90066-2622
(301) 751-1173
Mailing address
12099 W WASHINGTON BLVD STE 200, LOS ANGELES, CA 90066-2622
(301) 751-1173
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
174400000X
Specialist
DATA ENTRY
CA
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C014257
IS ACCESS NUMBER
CA
01
—
PSIX455
PROVIDER NUMBER
CA
Enumeration date
03/27/2007
Last updated
09/24/2013
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