Provider Demographics
NPI:1902393432
Name:LOGAN, CECILE (LVN)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CECILE
Other - Middle Name:BARBETH
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:318 E HILLCREST BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2438
Mailing Address - Country:US
Mailing Address - Phone:323-428-8277
Mailing Address - Fax:
Practice Address - Street 1:318 E HILLCREST BLVD STE 6
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2438
Practice Address - Country:US
Practice Address - Phone:323-428-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183699164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse