Healthcare Provider Details

I. General information

NPI: 1811028202
Provider Name (Legal Business Name): LEONORE VILLALTA-MURPHY LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEONORE MURPHY-SURIANO LVN

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8171 VINCETTA DR APT 11
LA MESA CA
91942-2431
US

IV. Provider business mailing address

8171 VINCETTA DR APT 11
LA MESA CA
91942-2431
US

V. Phone/Fax

Practice location:
  • Phone: 619-665-9692
  • Fax:
Mailing address:
  • Phone: 619-665-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN158739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: