Individual
ANGELLENA LAVAL DESOUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
12240 HESPERIA RD, VICTORVILLE, CA 92395-8309
(760) 245-8837
Mailing address
12240 HESPERIA RD, VICTORVILLE, CA 92395-8309
(760) 245-8837
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
282758
CA
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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