Active NPI
Dianne Longo
- Sports Medicine (Family Medicine) Physician
- Fullerton, CA
National Provider Identifier
1720403553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 2251P0200X
- Practice address
- 1319 Evergreen Ave
Apt N2
Fullerton, CA 92835-2063 - Phone
- (714) 697-8359
- NPI assigned
- Mar 3, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 2251P0200X | CA | Primary |
Addresses
Primary practice location
1319 Evergreen Ave
Apt N2
Fullerton, CA 92835-2063
Mailing address
1319 Evergreen Ave
Apt N2
Fullerton, CA 92835-2063
Phone (714) 697-8359
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2251P0200X | CA | MD | Sports Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393804800000",
"number": "1720403553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1319 EVERGREEN AVE",
"address_2": "APT N2",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928352063",
"telephone_number": "714-697-8359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1319 EVERGREEN AVE",
"address_2": "APT N2",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928352063",
"telephone_number": "714-697-8359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGO",
"first_name": "DIANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-03",
"last_updated": "2014-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "CA",
"license": "2251P0200X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.