=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972376366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONIZA BEL VASQUEZ LABAGNOY NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2023
-----------------------------------------------------
Last Update Date | 07/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5015 EAGLE ROCK BLVD STE 210
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90041-2085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-300-7541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21121 COHASSET ST
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-491-6397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95025805
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------