Healthcare Provider Details

I. General information

NPI: 1073807012
Provider Name (Legal Business Name): MARYJANE HUGHES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3674
US

IV. Provider business mailing address

11721 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3674
US

V. Phone/Fax

Practice location:
  • Phone: 562-801-0318
  • Fax: 562-949-3642
Mailing address:
  • Phone: 562-801-0318
  • Fax: 562-949-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number253567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: