Provider Demographics
NPI:1457057028
Name:NASH, LALAINE RUIZ-FORTUNA (FNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:LALAINE
Middle Name:RUIZ-FORTUNA
Last Name:NASH
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:LALAINE
Other - Middle Name:RUIZ
Other - Last Name:FORTUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6210 WINANS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2251
Mailing Address - Country:US
Mailing Address - Phone:213-841-4165
Mailing Address - Fax:
Practice Address - Street 1:6210 WINANS DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-2251
Practice Address - Country:US
Practice Address - Phone:213-841-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95023943OtherNURSE PRACTITIONER