=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164232401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SREEDEVI SUNIL WARRIER CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2025
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 W CARSON ST
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90502-2059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-306-5546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24681 SHADOWFAX DR
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-246-8291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
-----------------------------------------------------
License Number | 3462
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------