Organization Active NPI

Diamond Life Diamond Surgical

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1417750159
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DIAMOND LIFE DIAMOND SURGICAL
Practice address
1561 Westwood Blvd
Los Angeles, CA 90024-5601
Phone
(323) 736-0096
NPI assigned
Mar 28, 2025
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maximo DiamondNPI 1063519932
Title
Owner
Phone
(323) 736-0096

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1561 Westwood Blvd
Los Angeles, CA 90024-5601

Mailing address

1561 Westwood Blvd
Los Angeles, CA 90024-5601

National Provider Directory

National Provider Directory

Locations

1561 Westwood Blvd
Los Angeles, CA 90024
Phone (323) 736-0096

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1417750159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1561 WESTWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900245601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1561 WESTWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900245601",
            "telephone_number": "323-736-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMOND LIFE DIAMOND SURGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-28",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "DIAMOND",
        "authorized_official_first_name": "MAXIMO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-736-0096"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.