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General NPI Number Information
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NPI Number | 1144817610
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Entity Type | Individual
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Provider Name | MARY JOSEPHINE GREENDALE LVN
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Gender | Female
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 4023 MARINE AVE
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City | LAWNDALE
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State | CA
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Zip | 90260-1840
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Country | US
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Telephone | 310-675-9555
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Fax |
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Provider Business Mailing Address
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Address Line | 26460 SUMMIT CIR
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2991
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Country | US
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Telephone | 909-753-5763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 247161
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License Number State | CA
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