Provider Demographics
NPI:1003221722
Name:FALLEY, ALBERT (LVN)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:FALLEY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:8925 WEST K STREET
Mailing Address - City:SOUTH DOS PALOS
Mailing Address - State:CA
Mailing Address - Zip Code:93665-0387
Mailing Address - Country:US
Mailing Address - Phone:209-392-3240
Mailing Address - Fax:
Practice Address - Street 1:301 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6211
Practice Address - Country:US
Practice Address - Phone:209-386-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN281175164X00000X
CAVN 281175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse