Healthcare Provider Details

I. General information

NPI: 1407624901
Provider Name (Legal Business Name): MAREN ASHLEY ATTANASIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 CHALCEDONY ST UNIT 11
SAN DIEGO CA
92109-3410
US

IV. Provider business mailing address

9300 CAMPUS POINT DR # 7-613
LA JOLLA CA
92037-1300
US

V. Phone/Fax

Practice location:
  • Phone: 619-339-9088
  • Fax:
Mailing address:
  • Phone: 858-657-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number5026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: