Healthcare Provider Details

I. General information

NPI: 1346306917
Provider Name (Legal Business Name): CHEROKEE LYNETTE LAVALLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
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

761 REDONDO AVE
LONG BEACH CA
90804-5140
US

V. Phone/Fax

Practice location:
  • Phone: 323-242-0139
  • Fax: 323-242-0149
Mailing address:
  • Phone: 213-804-6996
  • Fax: 323-242-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number16818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: