Healthcare Provider Details

I. General information

NPI: 1639083728
Provider Name (Legal Business Name): AIDEE VERONICA OLIVA ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 MARENGO ST
LOS ANGELES CA
90033-1319
US

IV. Provider business mailing address

14200 POLK ST UNIT 50
SYLMAR CA
91342-2966
US

V. Phone/Fax

Practice location:
  • Phone: 213-989-7700
  • Fax:
Mailing address:
  • Phone: 818-617-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number759856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: