Individual
MS. DIANNE MITSUKO ITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
4650 SUNSET BOULEVARD, MAILSTOP #81, LOS ANGELES, CA 90027-0980
(323) 361-3033
(323) 361-8191
Mailing address
PO BOX 3162, DANA POINT, CA 92629-8162
(949) 275-3265
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
457020
CA
Other
Enumeration date
04/13/2010
Last updated
04/13/2010
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