Healthcare Provider Details

I. General information

NPI: 1982441234
Provider Name (Legal Business Name): STEPHANIE FLORESCA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CENTRAL AVE
GLENDALE CA
91204-2594
US

IV. Provider business mailing address

1701 SUNNY HEIGHTS DR
LOS ANGELES CA
90065-3320
US

V. Phone/Fax

Practice location:
  • Phone: 818-502-1900
  • Fax:
Mailing address:
  • Phone: 213-407-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95071514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: