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General NPI Number Information
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NPI Number | 1386431047
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Entity Type | Individual
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Provider Name | KATHRYN N REALYVASQUEZ LVN
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Gender | Female
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1926 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-2402
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Country | US
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Telephone | 213-722-4217
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Fax |
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Provider Business Mailing Address
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Address Line | 133 S SWALL DR APT 1
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City | LOS ANGELES
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State | CA
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Zip | 90048-3032
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Country | US
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Telephone | 909-331-0593
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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 | VN736801
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License Number State | CA
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