Healthcare Provider Details

I. General information

NPI: 1184481699
Provider Name (Legal Business Name): LIA MARESCA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

IV. Provider business mailing address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

V. Phone/Fax

Practice location:
  • Phone: 310-680-8536
  • Fax:
Mailing address:
  • Phone: 310-680-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95185166
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: