Healthcare Provider Details

I. General information

NPI: 1861711780
Provider Name (Legal Business Name): NENA B. LAROZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15237 CALLE JUANITO
SAN DIEGO CA
92129-1010
US

IV. Provider business mailing address

15237 CALLE JUANITO
SAN DIEGO CA
92129-1010
US

V. Phone/Fax

Practice location:
  • Phone: 858-672-0409
  • Fax: 858-672-0409
Mailing address:
  • Phone: 858-672-0409
  • Fax: 858-672-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number374602831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: