Provider Demographics
NPI:1811028202
Name:VILLALTA-MURPHY, LEONORE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:LEONORE
Middle Name:
Last Name:VILLALTA-MURPHY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:LEONORE
Other - Middle Name:
Other - Last Name:MURPHY-SURIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:8171 VINCETTA DR APT 11
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2431
Mailing Address - Country:US
Mailing Address - Phone:619-665-9692
Mailing Address - Fax:
Practice Address - Street 1:8171 VINCETTA DR APT 11
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2431
Practice Address - Country:US
Practice Address - Phone:619-665-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN158739164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS013930OtherMCL PROVIDER
CA1811028202OtherMEDICAL
CAVN158739OtherLICENSE VOCATIONAL NURSE