Provider Demographics
NPI:1942324967
Name:HAZEL, VASHTI (LVN)
Entity Type:Individual
Prefix:MRS
First Name:VASHTI
Middle Name:
Last Name:HAZEL
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 1:11057 BASYE STREET
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1655
Mailing Address - Country:US
Mailing Address - Phone:626-444-0539
Mailing Address - Fax:626-444-7990
Practice Address - Street 1:11057 BASYE STREET
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1655
Practice Address - Country:US
Practice Address - Phone:626-444-0539
Practice Address - Fax:626-444-7990
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN171454164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAS0714OtherSTAFF CODE