Provider Demographics
NPI:1841953247
Name:LOPEZ ORELLANA, VICKY (LVN)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:LOPEZ ORELLANA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:ESCOBEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1776 E CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3050
Mailing Address - Country:US
Mailing Address - Phone:323-374-6848
Mailing Address - Fax:
Practice Address - Street 1:1776 E CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3050
Practice Address - Country:US
Practice Address - Phone:323-374-6848
Practice Address - Fax:323-374-6691
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710649164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse