Provider Demographics
NPI:1972371607
Name:NXUMALO, LORRAINE TATENDA NOKUTHULA (PMHNP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:TATENDA NOKUTHULA
Last Name:NXUMALO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 CENTURY PARK E STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2905
Mailing Address - Country:US
Mailing Address - Phone:562-316-9662
Mailing Address - Fax:
Practice Address - Street 1:2029 CENTURY PARK EAST
Practice Address - Street 2:SUITE 400, OFFICE #422
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2905
Practice Address - Country:US
Practice Address - Phone:562-316-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028675363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health