Healthcare Provider Details

I. General information

NPI: 1609665439
Provider Name (Legal Business Name): MS. ROCIO Y MAYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAPLE AVE
LOS ANGELES CA
90014-2211
US

IV. Provider business mailing address

1040 HOLLISTER ST
SAN FERNANDO CA
91340-3616
US

V. Phone/Fax

Practice location:
  • Phone: 818-721-1303
  • Fax:
Mailing address:
  • Phone: 818-721-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberVN713612
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN713612
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number713612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: