Provider Demographics
NPI:1497919542
Name:VEDDER, SYLVIA INGRID (NP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:INGRID
Last Name:VEDDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:INGRID
Other - Last Name:MANGOWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 N BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-4225
Mailing Address - Country:US
Mailing Address - Phone:626-969-9219
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:626-969-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429776363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care