Provider Demographics
NPI:1780098400
Name:TEVES, LALA C (RN)
Entity type:Individual
Prefix:MS
First Name:LALA
Middle Name:C
Last Name:TEVES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CORAZON
Other - Middle Name:T
Other - Last Name:DE VERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18780 AMAR RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4559
Mailing Address - Country:US
Mailing Address - Phone:909-239-8820
Mailing Address - Fax:626-810-0086
Practice Address - Street 1:250 W ARTESIA ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1807
Practice Address - Country:US
Practice Address - Phone:909-623-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN481507163W00000X, 163WH0200X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice