Healthcare Provider Details

I. General information

NPI: 1801916226
Provider Name (Legal Business Name): MARIA THERESA ABE LLAMADO BSN RN PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 HOWARD AVE
SAN DIEGO CA
92104-1016
US

IV. Provider business mailing address

2020 HOWARD AVE
SAN DIEGO CA
92104
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-5966
  • Fax:
Mailing address:
  • Phone: 619-294-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number471911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: