Provider Demographics
NPI:1750386801
Name:LERNER, DIEGO FABIAN (MD)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:FABIAN
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 TORRANCE BLVD # 277
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4100
Mailing Address - Country:US
Mailing Address - Phone:310-540-4820
Mailing Address - Fax:888-945-3792
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6015
Practice Address - Country:US
Practice Address - Phone:310-540-4820
Practice Address - Fax:888-945-3792
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG732182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G732180Medicaid
CA00G732181Medicaid
CAG73218Medicare ID - Type Unspecified
CAG73218Medicare PIN
CA00G732181Medicaid