Provider Demographics
NPI:1376971804
Name:REBOLLOSO, ERIKA (LVN)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:REBOLLOSO
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 1:16111 PRAIRIE AVE
Mailing Address - Street 2:APT 210
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16111 PRAIRIE AVE
Practice Address - Street 2:APT 210
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2743
Practice Address - Country:US
Practice Address - Phone:310-873-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267489164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse