Healthcare Provider Details

I. General information

NPI: 1225682461
Provider Name (Legal Business Name): ASHLEY CHRISTINE VIEIRA PNP, RN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

547 W FOOTHILL BLVD UNIT 88
GLENDORA CA
91741-2479
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2450
  • Fax:
Mailing address:
  • Phone: 951-903-8637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95012027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number95012027
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95012027
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95012027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: