Healthcare Provider Details

I. General information

NPI: 1013269349
Provider Name (Legal Business Name): EVELYN ROMERO SHERRY LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLZ
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

221 WESTWOOD PLZ
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7930
  • Fax: 310-267-1996
Mailing address:
  • Phone: 323-240-9395
  • Fax: 310-267-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN85586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: