Healthcare Provider Details

I. General information

NPI: 1124336458
Provider Name (Legal Business Name): VALENCIA OLA CHAVERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 STOCKER ST
LOS ANGELES CA
90008-5101
US

IV. Provider business mailing address

3751 STOCKER ST
LOS ANGELES CA
90008-5101
US

V. Phone/Fax

Practice location:
  • Phone: 323-298-3680
  • Fax: 323-292-0053
Mailing address:
  • Phone: 323-298-3680
  • Fax: 323-292-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number563928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: