Healthcare Provider Details

I. General information

NPI: 1437439155
Provider Name (Legal Business Name): GRACE MENE-MEREGILLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 LENZEN AVE
SAN JOSE CA
95126-2737
US

IV. Provider business mailing address

976 LENZEN AVE
SAN JOSE CA
95126-2737
US

V. Phone/Fax

Practice location:
  • Phone: 408-992-4905
  • Fax:
Mailing address:
  • Phone: 408-992-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number526591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: