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General NPI Number Information
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NPI Number | 1952436651
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Entity Type | Individual
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Provider Name | REVONIA J TRUBY NP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11905 SO CENTRAL AVE #201
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City | LOS ANGELES
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State | CA
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Zip | 90059
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Country | US
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Telephone | 323-566-6911
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Fax | 323-566-6896
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Provider Business Mailing Address
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Address Line | 4203 LEVELSIDE AVE
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City | LAKEWOOD
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State | CA
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Zip | 90712
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Country | US
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Telephone | 562-421-4375
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Fax | 323-566-6896
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP 1160
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 364SW0102X
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Taxonomy Name | Women's Health Clinical Nurse Specialist
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License Number | 202745
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License Number State | CA
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