=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619819703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAME CHANGER ALLIED HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2026
-----------------------------------------------------
Last Update Date | 04/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26625 ROUNDUP WAY
-----------------------------------------------------
City | APPLE VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92308-0542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-360-3779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26625 ROUNDUP WAY
-----------------------------------------------------
City | APPLE VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92308-0542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-360-3779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LETRICIA LADIAMOND WALTON
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 323-360-3779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------