Healthcare Provider Details

I. General information

NPI: 1437430675
Provider Name (Legal Business Name): LP.A. & T. CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 DIXON WAY
CHULA VISTA CA
91911
US

IV. Provider business mailing address

1262 DIXON WAY
CHULA VISTA CA
91911
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-6357
  • Fax: 619-422-1805
Mailing address:
  • Phone: 619-426-6357
  • Fax: 619-422-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN301810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN168658
License Number StateCA

VIII. Authorized Official

Name: MRS. LIBERTY CRUZ NELSON
Title or Position: PRESIDENT-OWNER
Credential: RN-BSN/DON/ADMINISTR
Phone: 619-216-6357