Healthcare Provider Details

I. General information

NPI: 1891905162
Provider Name (Legal Business Name): MARGARET HERMAN CIESLA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 212
SANTA MONICA CA
90404-2080
US

IV. Provider business mailing address

680 PALISADES DR
PACIFIC PALISADES CA
90272-2853
US

V. Phone/Fax

Practice location:
  • Phone: 310-433-5535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN241366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: