Provider Demographics
NPI:1881899359
Name:TEVES, LADY LOU SINCO (RN)
Entity type:Individual
Prefix:MS
First Name:LADY LOU
Middle Name:SINCO
Last Name:TEVES
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 1:991 LOTUS CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1579
Mailing Address - Country:US
Mailing Address - Phone:818-395-9279
Mailing Address - Fax:
Practice Address - Street 1:512 E WILSON AVE STE 400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4351
Practice Address - Country:US
Practice Address - Phone:818-507-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN500613163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse