MEDICARE: MARIA GRAZIELLA PROTACIO TO

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	95268576	CA

General Provider Information

NPI Number	:	1699626259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA GRAZIELLA PROTACIO TO

Provider Business Mailing Address
First Line	:	3494 WIMBLEDON WAY
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1642
Country	:	US
Telephone Number	:	773-865-5177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3494 WIMBLEDON WAY
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1642
Country	:	US
Telephone Number	:	773-865-5177
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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