Healthcare Provider Details

I. General information

NPI: 1962425413
Provider Name (Legal Business Name): JERI LORRAINE MALDONADO NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11331 NEWGATE AVE
WHITTIER CA
90605-3724
US

IV. Provider business mailing address

11331 NEWGATE AVE
WHITTIER CA
90605-3724
US

V. Phone/Fax

Practice location:
  • Phone: 562-941-8639
  • Fax:
Mailing address:
  • Phone: 562-941-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT30009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: