Healthcare Provider Details

I. General information

NPI: 1447506753
Provider Name (Legal Business Name): GUADALUPE PRECIADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3591 E IMPERIAL HWY
LYNWOOD CA
90262-2654
US

IV. Provider business mailing address

1910 W SUNSET BLVD 650
LOS ANGELES CA
90026-3275
US

V. Phone/Fax

Practice location:
  • Phone: 310-638-9025
  • Fax: 310-638-9080
Mailing address:
  • Phone: 213-484-1186
  • Fax: 213-484-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN161104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: