Healthcare Provider Details

I. General information

NPI: 1184185290
Provider Name (Legal Business Name): PAUL LLAMOSO NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 E FLORENCE AVE
HUNTINGTON PARK CA
90255-5837
US

IV. Provider business mailing address

22423 FRIES AVE
CARSON CA
90745-4015
US

V. Phone/Fax

Practice location:
  • Phone: 323-587-7771
  • Fax:
Mailing address:
  • Phone: 310-347-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: