| Doctor Name: | MR. WTIN JALANUGRAHA |
| NPI Number: | 1508118845 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LVN |
| License Number: | 148439 |
| Business Practice Address: | Ucla Student Health Services 221 Westwood Plaza Los Angeles, CA - 900950001 |
| Business Phone Number: | 3108254073 |
| Business Fax Number: | |
| Mailing Address: | 4323 Van Nuys Blvd, Apt 3 SHERMAN OAKS |
| State: | CA |
| Postal Code: | 914033728 |
| Phone Number: | 8187847818 |
| Fax Number: | |
| NPI Enumeration Date: | 10/10/2012 |
| NPI Last Update Date: | 10/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 164X00000X |
| License Number: | 148439 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Licensed Vocational Nurse |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states. |