Healthcare Provider Details

I. General information

NPI: 1326240391
Provider Name (Legal Business Name): XENIA ANTONIO LOYOLA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 N FAIRFAX AVE SUITE #200
WEST HOLLYWOOD CA
90046-7204
US

IV. Provider business mailing address

4141 VIA MARISOL UNIT # 421
LOS ANGELES CA
90042-5141
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-2011
  • Fax:
Mailing address:
  • Phone: 213-324-2773
  • Fax: 323-225-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN212154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: