Provider Demographics
NPI:1346989217
Name:PINEDA, LARISSA ISABEL (LVN)
Entity Type:Individual
Prefix:MISS
First Name:LARISSA
Middle Name:ISABEL
Last Name:PINEDA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22030 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2303
Mailing Address - Country:US
Mailing Address - Phone:818-522-7281
Mailing Address - Fax:
Practice Address - Street 1:6368 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-6320
Practice Address - Country:US
Practice Address - Phone:818-522-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695686164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA695686OtherBOARD OF VOCATIONAL NURSING AND PSYCHIATRIC TECHNICIANS