Healthcare Provider Details

I. General information

NPI: 1780457507
Provider Name (Legal Business Name): MARIA MOYER LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS MARIA VALENTINE

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24790 VALLEY ST
SANTA CLARITA CA
91321-2629
US

IV. Provider business mailing address

7109 GLORIA AVE
VAN NUYS CA
91406-4009
US

V. Phone/Fax

Practice location:
  • Phone: 661-670-2020
  • Fax:
Mailing address:
  • Phone: 323-386-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number284056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: