Basic Information
| Provider Information | |||||||||
| NPI: | 1245362375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBAYALDE | ||||||||
| FirstName: | SHALANI | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 PARK PLAZA DR STE 150 | ||||||||
| Address2: | ATTN CINDY SPRINGER MS 6135 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622073607 | ||||||||
| FaxNumber: | 5627414413 | ||||||||
| Practice Location | |||||||||
| Address1: | 12900 PARK PLAZA DR STE 150 | ||||||||
| Address2: | ATTN CINDY SPRINGER MS 6135 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622073607 | ||||||||
| FaxNumber: | 5627414413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 06/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP 15282 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | MT 1408841 | 01 | AR | DEA | OTHER | NP 15282 | 01 | CA | NURSE PRACTITIONER | OTHER | RN 521159 | 01 | CA | REGISTERED NURSE LICENSE | OTHER |