Provider Demographics
NPI:1457583346
Name:VALLICELLA, CLODI (RN)
Entity Type:Individual
Prefix:
First Name:CLODI
Middle Name:
Last Name:VALLICELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S ARROYO PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3911
Mailing Address - Country:US
Mailing Address - Phone:626-403-4888
Mailing Address - Fax:626-403-4894
Practice Address - Street 1:1020 S ARROYO PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3911
Practice Address - Country:US
Practice Address - Phone:626-403-4888
Practice Address - Fax:626-403-4894
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402459163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health