Healthcare Provider Details

I. General information

NPI: 1598893687
Provider Name (Legal Business Name): CAROL DIANE LA VAL RN-C, FNP, MN, MAED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S HUDSON AVE
PASADENA CA
91101-3507
US

IV. Provider business mailing address

11342 ORO VISTA AVE
SUNLAND CA
91040-2031
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-6981
  • Fax: 626-584-1540
Mailing address:
  • Phone: 818-353-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN357592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: