Provider Demographics
NPI:1447496963
Name:PRICE, CONCHITA ANNE (LVN)
Entity type:Individual
Prefix:
First Name:CONCHITA
Middle Name:ANNE
Last Name:PRICE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 PORTSALON WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8654
Mailing Address - Country:US
Mailing Address - Phone:925-565-3333
Mailing Address - Fax:
Practice Address - Street 1:4895 PORTSALON WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8654
Practice Address - Country:US
Practice Address - Phone:925-565-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 235938164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse