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General NPI Number Information
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NPI Number | 1306504451
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Entity Type | Individual
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Provider Name | MARIA DOLORES VICUNA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 30 HUNTER LN
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City | CAMP HILL
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State | PA
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Zip | 17011-2400
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Country | US
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Telephone | 800-748-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 12050 ACEVES AVE
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City | OROSI
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State | CA
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Zip | 93647-2627
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Country | US
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Telephone | 559-305-3166
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95228378
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License Number State | CA
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