Individual
LEIRA VIDAL MARTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8900 BEVERLY BLVD, WEST HOLLYWOOD, CA 90048-2438
(310) 423-7249
Mailing address
6419 VANALDEN AVE, RESEDA, CA 91335-5971
(714) 930-5883
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95018934
CA
363LA2100X
Acute Care Nurse Practitioner
95018934
CA
Other
Enumeration date
11/30/2021
Last updated
12/22/2021
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