Provider Demographics
NPI:1780284380
Name:CONCEPCION, JOSEPHINE ESTRADA (LVN)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ESTRADA
Last Name:CONCEPCION
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 1:1889 W REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3119
Mailing Address - Country:US
Mailing Address - Phone:909-501-5167
Mailing Address - Fax:
Practice Address - Street 1:1889 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3119
Practice Address - Country:US
Practice Address - Phone:909-501-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN702802164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse