Healthcare Provider Details

I. General information

NPI: 1043007404
Provider Name (Legal Business Name): LATASHA LUNN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14240 IMPERIAL HWY
LA MIRADA CA
90638-1940
US

IV. Provider business mailing address

14240 IMPERIAL HWY
LA MIRADA CA
90638-1940
US

V. Phone/Fax

Practice location:
  • Phone: 562-946-1587
  • Fax:
Mailing address:
  • Phone: 562-946-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN198406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: