MEDICARE: MAE KHRISTINE UBALDO ADRIANO CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	95007620	CA

General Provider Information

NPI Number	:	1285146977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAE KHRISTINE UBALDO ADRIANO CPNP

Provider Business Mailing Address
First Line	:	15109 TUBA ST
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2734
Country	:	US
Telephone Number	:	310-963-1589
Fax Number	:

Provider Business Practice Location Address
First Line	:	12540 PIERCE ST
Second Line	:
City	:	PACOIMA
State	:	CA
Zip	:	91331-1701
Country	:	US
Telephone Number	:	818-897-2193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	03/27/2023

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