Healthcare Provider Details

I. General information

NPI: 1477839462
Provider Name (Legal Business Name): BLESS LOZA VALECRUZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2011
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 FAIRVIEW AVE APT 2
LOS ANGELES CA
90033-1632
US

IV. Provider business mailing address

571 FAIRVIEW AVE APT 2
LOS ANGELES CA
90033-1632
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-0082
  • Fax:
Mailing address:
  • Phone: 323-223-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number23034
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68594
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number535891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: