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NPI Code Detail

MEDICARE: ALEXANDRA MARIE GOMEZ PENA LVN

MEDICARE: ALEXANDRA MARIE GOMEZ PENA LVN
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
1164X00000XLicensed Vocational Nurse741187CA

General Provider Information

NPI Number : 1366374001
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA MARIE GOMEZ PENA LVN
Provider Business Mailing Address
First Line : 3310 W CENTURY BLVD
Second Line :
City : INGLEWOOD
State : CA
Zip : 90303-1305
Country : US
Telephone Number : 323-765-6165
Fax Number :
Provider Business Practice Location Address
First Line : 3310 W CENTURY BLVD
Second Line :
City : INGLEWOOD
State : CA
Zip : 90303-1305
Country : US
Telephone Number : 323-765-6165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2026
Last Update Date : 05/29/2026

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