Provider Demographics
NPI:1730944133
Name:DILORENZO, DESIREE JEAN (DC)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:JEAN
Last Name:DILORENZO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 PACIFIC COAST HWY APT 24
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3132
Mailing Address - Country:US
Mailing Address - Phone:818-744-6449
Mailing Address - Fax:
Practice Address - Street 1:10474 SANTA MONICA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6931
Practice Address - Country:US
Practice Address - Phone:310-470-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36891111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation