Basic Information
Provider Information
NPI: 1376146571
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANCO
FirstName: ELIZABETH
MiddleName: BUSTOS
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 21420 PLANE TREE LN
Address2:  
City: SANTA CLARITA
State: CA
PostalCode: 913214473
CountryCode: US
TelephoneNumber: 8186528348
FaxNumber:  
Practice Location
Address1: 8142 SUNLAND BLVD
Address2:  
City: SUN VALLEY
State: CA
PostalCode: 91352
CountryCode: US
TelephoneNumber: 8185828832
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/19/2020
LastUpdateDate: 11/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
374700000X  Y Nursing Service Related ProvidersTechnician 

No ID Information.


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