MEDICARE: MARY VIVIAN M ARANDA BSN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	637598	CA
2	163WC0400X	Case Management Registered Nurse	637598	CA
3	163WC2100X	Continence Care Registered Nurse	637598	CA
4	163WG0600X	Gerontology Registered Nurse	637598	CA
5	163WI0500X	Infusion Therapy Registered Nurse	637598	CA
6	163WW0000X	Wound Care Registered Nurse	637598	CA
7	163WX1500X	Ostomy Care Registered Nurse	637598	CA
8	163WG0000X	General Practice Registered Nurse	637598	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588704449	OTHER	CA	HMO MEDICARE ADVANTAGE

General Provider Information

NPI Number	:	1447832175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY VIVIAN M ARANDA BSN RN

Provider Business Mailing Address
First Line	:	5508 CENTURY MANOR CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1808
Country	:	US
Telephone Number	:	408-416-8846
Fax Number	:

Provider Business Practice Location Address
First Line	:	5988 SILVER CREEK VALLEY RD STE 60
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1077
Country	:	US
Telephone Number	:	408-363-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	04/22/2021

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