Healthcare Provider Details

I. General information

NPI: 1720815574
Provider Name (Legal Business Name): MY FRIEND'S A NURSE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 ROYAL AVE STE 105
SIMI VALLEY CA
93065-4666
US

IV. Provider business mailing address

2045 ROYAL AVE STE 105
SIMI VALLEY CA
93065-4666
US

V. Phone/Fax

Practice location:
  • Phone: 818-919-0152
  • Fax:
Mailing address:
  • Phone: 805-657-2507
  • Fax: 805-209-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. COLETTE WAGHOLIKAR
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 818-919-0152