Healthcare Provider Details

I. General information

NPI: 1831600576
Provider Name (Legal Business Name): LOVELLE C. VALENCIA NP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2017
Last Update Date: 10/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6856 PETIT AVE
LAKE BALBOA CA
91406-4614
US

IV. Provider business mailing address

23150 AVENUE SAN LUIS APT 209
WOODLAND HILLS CA
91364-1037
US

V. Phone/Fax

Practice location:
  • Phone: 213-531-0071
  • Fax: 833-531-0070
Mailing address:
  • Phone: 818-741-7436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005991
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005991
License Number StateCA

VIII. Authorized Official

Name: LOVELLE CHRISTINE VALENCIA
Title or Position: SOLE PROPRIETOR
Credential: NURSE PRACTITIONER
Phone: 213-531-0071