MEDICARE: TATIANA VALLEJO ALBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	694765	CA

General Provider Information

NPI Number	:	1114880549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA VALLEJO ALBA

Provider Business Mailing Address
First Line	:	607 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3211
Country	:	US
Telephone Number	:	323-268-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3211
Country	:	US
Telephone Number	:	323-268-9191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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