Healthcare Provider Details

I. General information

NPI: 1265672240
Provider Name (Legal Business Name): CATHERINE MANIAGO VASKO RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE 200
ORANGE CA
92868-4304
US

IV. Provider business mailing address

25 SAGEBRUSH
IRVINE CA
92618-4052
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-1800
  • Fax: 714-835-1811
Mailing address:
  • Phone: 714-835-1800
  • Fax: 714-835-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number429536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: