Individual
PRICILLA ADELIA REQUENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11118 S OSAGE AVE APT 7, INGLEWOOD, CA 90304-2967
(424) 581-2844
(424) 581-2844
Mailing address
11118 S OSAGE AVE APT 7, INGLEWOOD, CA 90304-2967
(424) 581-2844
(424) 581-2844
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
123765
CA
376K00000X
Nurse's Aide
NON
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F1168310
—
CA
Enumeration date
09/22/2021
Last updated
09/22/2021
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