Healthcare Provider Details

I. General information

NPI: 1780098400
Provider Name (Legal Business Name): LALA C TEVES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CORAZON T DE VERA

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W ARTESIA ST
POMONA CA
91768-1807
US

IV. Provider business mailing address

18780 AMAR RD STE 202
WALNUT CA
91789-4559
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-7100
  • Fax:
Mailing address:
  • Phone: 909-239-8820
  • Fax: 626-810-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN481507
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN481507
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN481507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: