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General NPI Number Information
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NPI Number | 1386444206
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Entity Type | Individual
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Provider Name | MYRNA CORPUZ
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Gender | Female
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 212 CARMEN LN STE 201
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City | SANTA MARIA
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State | CA
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Zip | 93458-7771
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Country | US
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Telephone | 805-260-9324
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Fax | 805-728-9492
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Provider Business Mailing Address
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Address Line | 514 EMBASSY AVE
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City | SANTA MARIA
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State | CA
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Zip | 93458-1090
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Country | US
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Telephone |
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 689758
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License Number State | CA
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