Provider Demographics
NPI:1861800724
Name:KATTENGELL, DIANNA (OD)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:KATTENGELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ARGYLE AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3335
Mailing Address - Country:US
Mailing Address - Phone:210-365-4744
Mailing Address - Fax:
Practice Address - Street 1:1431 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2638
Practice Address - Country:US
Practice Address - Phone:310-395-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15038OtherCALIFORNIA STATE BOARD OF OPTOMETRY