Healthcare Provider Details

I. General information

NPI: 1730643925
Provider Name (Legal Business Name): VINNIE LAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ROSECRANS AVE STE 3290
EL SEGUNDO CA
90245-4771
US

IV. Provider business mailing address

22715 LADEENE AVE
TORRANCE CA
90505-3440
US

V. Phone/Fax

Practice location:
  • Phone: 323-628-8671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number776717
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: