Provider Demographics
NPI:1033535794
Name:HALL, TRUSANA MONIQUE (LICENSED VOCATIONAL)
Entity Type:Individual
Prefix:MS
First Name:TRUSANA
Middle Name:MONIQUE
Last Name:HALL
Suffix:
Gender:F
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 S. HALLDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062
Mailing Address - Country:US
Mailing Address - Phone:323-877-3030
Mailing Address - Fax:323-291-8930
Practice Address - Street 1:4103 S. HALLDALE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062
Practice Address - Country:US
Practice Address - Phone:323-877-3030
Practice Address - Fax:323-291-8930
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN223379164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse