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General NPI Number Information
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NPI Number | 1770992323
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Entity Type | Individual
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Provider Name | NETTIE HOUSE L.V.N
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Gender | Female
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 1000 CORPORATE CENTER DR SUITE 110
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City | MONTEREY PARK
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State | CA
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Zip | 91754-7600
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Country | US
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Telephone | 800-350-1323
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Fax |
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Provider Business Mailing Address
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Address Line | 17150 SAN MATEO ST APT D-19
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3669
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Country | US
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Telephone | 714-962-6806
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 120349
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License Number State | CA
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