Healthcare Provider Details

I. General information

NPI: 1386988277
Provider Name (Legal Business Name): ELIZABETH A. HUNTER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ 530
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

200 MEDICAL PLZ 530
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7922
  • Fax: 310-267-1899
Mailing address:
  • Phone: 310-825-7922
  • Fax: 310-267-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 682268
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN 682268
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN 682268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: