Provider Demographics
NPI:1639313547
Name:FRASER, LUZVIMINDA A (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LUZVIMINDA
Middle Name:A
Last Name:FRASER
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 1:8881 HELEN JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3744
Mailing Address - Country:US
Mailing Address - Phone:858-337-1613
Mailing Address - Fax:
Practice Address - Street 1:918 10TH ST APT 2
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2853
Practice Address - Country:US
Practice Address - Phone:619-435-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN130909164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse