Healthcare Provider Details

I. General information

NPI: 1285852855
Provider Name (Legal Business Name): PINK LOTUS HEALTH CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 S VERMONT AVE
LOS ANGELES CA
90044-3112
US

IV. Provider business mailing address

10024 S VERMONT AVE
LOS ANGELES CA
90044-3112
US

V. Phone/Fax

Practice location:
  • Phone: 323-242-0139
  • Fax: 323-242-0149
Mailing address:
  • Phone: 323-242-0139
  • Fax: 323-242-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number16818
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberG42217
License Number StateCA

VIII. Authorized Official

Name: CHEROKEE LYNETTE LAVALLEY
Title or Position: PRESIDENT
Credential: N.P.
Phone: 562-310-6996