Healthcare Provider Details

I. General information

NPI: 1003221722
Provider Name (Legal Business Name): ALBERT FALLEY LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

PO BOX 387 8925 WEST K STREET
SOUTH DOS PALOS CA
93665-0387
US

V. Phone/Fax

Practice location:
  • Phone: 209-386-1096
  • Fax:
Mailing address:
  • Phone: 209-392-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN281175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberVN 281175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: