Healthcare Provider Details

I. General information

NPI: 1801843941
Provider Name (Legal Business Name): LISA ANNE YOUNGBLOOD RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANNE CATAREVAS

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 WILSHIRE BLVD STE 1705
LOS ANGELES CA
90017-5600
US

IV. Provider business mailing address

103 HALF MOON CIR APT C2
HYPOLUXO FL
33462-5494
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-0670
  • Fax: 619-667-0815
Mailing address:
  • Phone: 515-381-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP11105
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11011940
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN481125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: