Provider Demographics
NPI:1790434363
Name:VERDUZCO, JOHANNA (LVN)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:VERDUZCO
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 1:12773 ARENA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2303
Mailing Address - Country:US
Mailing Address - Phone:909-576-3458
Mailing Address - Fax:
Practice Address - Street 1:17695 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4041
Practice Address - Country:US
Practice Address - Phone:909-854-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN697755164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse