Healthcare Provider Details

I. General information

NPI: 1205606167
Provider Name (Legal Business Name): LANI DELA NOCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 03/28/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CABRILLO PARK DR STE 120
SANTA ANA CA
92701-5029
US

IV. Provider business mailing address

261 W HOWARD ST
PASADENA CA
91103-1529
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-5038
  • Fax: 714-558-6038
Mailing address:
  • Phone: 213-631-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFNP95028705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: