1255407292 NPI number — VNA OF GREATER LOS ANGELES, INC.

Table of content: SUZANNE THERESA PROULX R.D. (NPI 1609095959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255407292 NPI number — VNA OF GREATER LOS ANGELES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VNA OF GREATER LOS ANGELES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255407292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1249 S DIAMOND BAR BLVD PMB 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIAMOND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91765-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-568-2588
Provider Business Mailing Address Fax Number:
949-263-4762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 S PROSPECTORS RD STE G-100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIAMOND BAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91765-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-568-2588
Provider Business Practice Location Address Fax Number:
949-263-4762
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALIA
Authorized Official First Name:
RAJNIT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
626-568-2588

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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