Healthcare Provider Details

I. General information

NPI: 1104782457
Provider Name (Legal Business Name): IRINA CODREANU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16906 MARLIN PL
VAN NUYS CA
91406-4525
US

IV. Provider business mailing address

16906 MARLIN PL
VAN NUYS CA
91406-4525
US

V. Phone/Fax

Practice location:
  • Phone: 850-842-8320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number195850453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: