Healthcare Provider Details

I. General information

NPI: 1245350461
Provider Name (Legal Business Name): ADOWA SERWA OSEI NYARKO RN. CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GIFTY LA VAR DAVIS RN. CCM

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24910 AVENUE TIBBITTS STE 5
VALENCIA CA
91355-3426
US

IV. Provider business mailing address

24910 AVENUE TIBBITTS
VALENCIA CA
91355-3426
US

V. Phone/Fax

Practice location:
  • Phone: 661-771-6609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number790732
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4205479
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number790732
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number790732
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number790732
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number790732
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number790732
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number790732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: