Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP16644 | CA |
NPI | 1013102789 |
---|---|
Provider Name | Ms. Valerie J. Payne |
First Address | Sylmar, CA 91342 |
Second Address | Sylmar, CA 91342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 06/09/2007 |