MEDICARE: MISS MARIA THERESA ABE LLAMADO BSN RN PHN

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	163WC1500X	Community Health Registered Nurse	471911	CA

General Provider Information

NPI Number	:	1801916226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA THERESA ABE LLAMADO BSN RN PHN

Provider Business Mailing Address
First Line	:	2020 HOWARD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104
Country	:	US
Telephone Number	:	619-294-5966
Fax Number	:

Provider Business Practice Location Address
First Line	:	2022 HOWARD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1016
Country	:	US
Telephone Number	:	619-294-5966
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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