1427700327 NPI number — TARA ADRIENNE LEA LVN, FNLP

Table of content: TARA ADRIENNE LEA LVN, FNLP (NPI 1427700327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427700327 NPI number — TARA ADRIENNE LEA LVN, FNLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEA
Provider First Name:
TARA
Provider Middle Name:
ADRIENNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LVN, FNLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427700327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34161 YUCAIPA BLVD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUCAIPA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92399-6109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-797-1277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34161 YUCAIPA BLVD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCAIPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92399-6109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-797-1277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)