Individual
AUDREY JOAN REALEZA CANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1223 16TH ST STE 3100, SANTA MONICA, CA 90404-1275
(424) 259-8791
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP95010935
CA
363LA2200X
Adult Health Nurse Practitioner
NP95010935
CA
363LF0000X
Family Nurse Practitioner
NP95010935
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
NP95010935
CA
Other
Enumeration date
05/10/2019
Last updated
12/30/2020
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