Healthcare Provider Details

I. General information

NPI: 1619807161
Provider Name (Legal Business Name): MAYRA JUDITH FIGUEROA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

V. Phone/Fax

Practice location:
  • Phone: 323-825-8300
  • Fax: 866-372-2719
Mailing address:
  • Phone: 323-825-8300
  • Fax: 866-372-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN743344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: