Healthcare Provider Details

I. General information

NPI: 1952666000
Provider Name (Legal Business Name): AZUCENA PALENZUELA VASQUEZ-LAWSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2012
Last Update Date: 07/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 MARION DR
GLENDALE CA
91205-3722
US

IV. Provider business mailing address

1623 MARION DR
GLENDALE CA
91205-3722
US

V. Phone/Fax

Practice location:
  • Phone: 818-437-8076
  • Fax: 323-927-1628
Mailing address:
  • Phone: 818-437-8076
  • Fax: 323-927-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP1700X
TaxonomyPerinatal Clinical Nurse Specialist
License Number267072
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW0000963995
License Number StateZZ
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number267072
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number267072
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number267072
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number267072
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number267072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: