Healthcare Provider Details

I. General information

NPI: 1447793211
Provider Name (Legal Business Name): MARY KATHERINE LLARENA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E MAIN ST STE 101
SANTA MARIA CA
93454
US

IV. Provider business mailing address

1510 E MAIN ST STE 101
SANTA MARIA CA
93454-4825
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-0610
  • Fax: 805-928-0680
Mailing address:
  • Phone: 805-928-0610
  • Fax: 805-928-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: