Healthcare Provider Details

I. General information

NPI: 1194474486
Provider Name (Legal Business Name): ANNIEBETH NACINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3086 FLORENCE PARK DR
SAN JOSE CA
95135-2050
US

IV. Provider business mailing address

3086 FLORENCE PARK DR
SAN JOSE CA
95135-2050
US

V. Phone/Fax

Practice location:
  • Phone: 863-446-1943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95192593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: