Individual
DR. DIANE JOYCE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2300 S FLOWER ST, SUITE 300, LOS ANGELES, CA 90007-2660
(213) 742-1433
(213) 742-1496
Mailing address
2300 S FLOWER ST, SUITE 300, LOS ANGELES, CA 90007-2677
(213) 742-1433
(213) 742-1496
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
G22020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G220200
MEDI-CAL NUMBER
CA
01
—
CGP168503
CCS PROVIDER NUMBER
CA
Enumeration date
09/06/2006
Last updated
07/08/2007
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