Healthcare Provider Details

I. General information

NPI: 1306049416
Provider Name (Legal Business Name): MARY ANN FIAMINGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S BASCOM AVE DIABETES ED
SAN JOSE CA
95128-2603
US

IV. Provider business mailing address

1177 AVALON DR
SAN JOSE CA
95125-4218
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax:
Mailing address:
  • Phone: 408-265-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN262901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: