Healthcare Provider Details

I. General information

NPI: 1629372636
Provider Name (Legal Business Name): GIANINA LUDUSAN RN,BSN,PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NORTH FLOWER STREET
SANTA ANA CA
92703
US

IV. Provider business mailing address

P.O . BOX 5133
ANAHEIM CA
92814-0220
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number701136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: