Healthcare Provider Details

I. General information

NPI: 1144671124
Provider Name (Legal Business Name): MAURITHA ALLEN-LEHEW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19059 BEAR VALLEY RD
APPLE VALLEY CA
92308-2716
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 760-515-5000
  • Fax: 760-240-3848
Mailing address:
  • Phone: 562-677-2409
  • Fax: 563-741-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95003738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: