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General NPI Number Information
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NPI Number | 1255194072
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Entity Type | Individual
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Provider Name | MIRIAM KARINA VALLEJO UGALDE MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 2271 E PALMDALE BLVD STE E
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City | PALMDALE
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State | CA
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Zip | 93550-1340
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Country | US
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Telephone | 661-538-9922
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Fax | 661-538-9199
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Provider Business Mailing Address
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Address Line | 5931 REDMAN AVE
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City | WHITTIER
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State | CA
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Zip | 90606-1052
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Country | US
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Telephone | 562-665-9392
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95026156
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License Number State | CA
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