Healthcare Provider Details

I. General information

NPI: 1265893135
Provider Name (Legal Business Name): ADAN KINTANAR LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HURLBUT ST
PASADENA CA
91105-4025
US

IV. Provider business mailing address

36 S KINNELOA AVE
PASADENA CA
91107-3853
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4221
  • Fax:
Mailing address:
  • Phone: 626-844-3033
  • Fax: 626-844-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number160818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: