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General NPI Number Information
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NPI Number | 1063591576
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Entity Type | Individual
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Provider Name | JILL E. MAITEN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2701 ATLANTIC AVE SUITE A
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City | LONG BEACH
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State | CA
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Zip | 90806-2701
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Country | US
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Telephone | 562-989-8449
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Fax | 562-989-8679
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Provider Business Mailing Address
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Address Line | 11272 LAMPSON AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5323
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Country | US
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Telephone | 714-636-3144
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Fax | 714-636-8703
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 529329
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License Number State | AL
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