Individual
MR. ROY VILLENA TATLONGHARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN-CANP
Contact information
Practice address
4650 SUNSET BLVD, MS 125, LOS ANGELES, CA 90027
(323) 361-2533
(323) 361-8095
Mailing address
P.O. BOX 27980, CHILDRENS HOSPITAL LOS ANGELES, MS 125, LOS ANGELES, CA 90027-0980
(323) 361-4206
(323) 361-8095
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
LIC#604372
CA
363LX0106X
Occupational Health Nurse Practitioner
LIC#604372
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15203
FURNISHING LICENSE
CA
Enumeration date
04/06/2010
Last updated
04/06/2010
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