Healthcare Provider Details

I. General information

NPI: 1265640957
Provider Name (Legal Business Name): MARIA ENRIQUETA PAYNE RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

600 SIERRA MEADOWS DR
SIERRA MADRE CA
91024-1135
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-6005
  • Fax:
Mailing address:
  • Phone: 626-355-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberNPF 1275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: