Individual
MRS. HEATHER DEL VILLAR BOGDANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1500 E. DUARTE ROAD, DUARTE, CA 91010
(626) 256-4673
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP 17636
CA
363LA2100X
Acute Care Nurse Practitioner
Primary
17636
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CNS 2814
CLINICAL NURSE SPECIALIST
CA
01
—
NP 17636
NURSE PRACTITIONER LICENS
CA
01
—
PHN 66386
PUBLIC HEALTHE NURSE
CA
01
—
RN 617845
REGISTERED NURSE LICENSE
CA
Enumeration date
04/09/2008
Last updated
11/12/2020
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