Kourtney Kate Vidal, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN726574 Issued in CA

Practice address

7742 Paseo del Rey Apt 6
Playa del Rey, CA 90293-8343

Phone

(562) 552-7646

NPI assigned

Jul 14, 2023

Last updated

Jul 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jairus Vidal Kleefisch Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1184303356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 N SEPULVEDA BLVD # 605",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902665111",
            "telephone_number": "424-542-1280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7742 PASEO DEL REY APT 6",
            "city": "PLAYA DEL REY",
            "state": "CA",
            "postal_code": "902938343",
            "telephone_number": "562-552-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "KOURTNEY",
        "middle_name": "KATE",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN726574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAIRUS",
            "last_name": "KLEEFISCH",
            "middle_name": "VIDAL",
            "credential": "LVN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sunbridge Hallmark Health Services LLC (Playa Del Rey Center)
• Yolanda Tay
• Amy Ravel Tinney, MSN, FNP-C, CPM , LM
• True Harmony Acupuncture Inc
• Frank Elias Velasco, PHD
• Lidia Vinci, M.A.
• Vitale Home Health Dba Vitale Nursing
• Dennis Waldman, D.D.S.
• Gene Arlan Ward, M.D.
• Chris Washington

• Licensed Vocational Nurse in Playa del Rey, CA
• Providers in Playa del Rey, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.