Healthcare Provider Details

I. General information

NPI: 1134405129
Provider Name (Legal Business Name): NERISSA PAGUIRIGAN CRISTOBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NERISSA ARCE PAGUIRIGAN

II. Dates (important events)

Enumeration Date: 10/23/2011
Last Update Date: 10/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 E COOLIDGE AVE
ORANGE CA
92867-5210
US

IV. Provider business mailing address

2624 E COOLIDGE AVE
ORANGE CA
92867-5210
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-2268
  • Fax:
Mailing address:
  • Phone: 714-639-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number00130365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number5537036735
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00400091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: