Provider Demographics
NPI:1053966994
Name:ASEMOTA, BEAUTY (LVN)
Entity type:Individual
Prefix:
First Name:BEAUTY
Middle Name:
Last Name:ASEMOTA
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 1:13931 CHADRON AVE APT 1513931
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8231
Mailing Address - Country:US
Mailing Address - Phone:323-312-4657
Mailing Address - Fax:
Practice Address - Street 1:13931 CHADRON AVE APT 15
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-8201
Practice Address - Country:US
Practice Address - Phone:323-312-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685658164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse