Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | NPF 1275 | CA |
NPI | 1265640957 |
---|---|
Provider Name | Maria Enriqueta Payne |
First Address | Sierra Madre, CA 91024-1135 |
Second Address | Pasadena, CA 91103-1620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NPF 1275 | NP FURNISHING NUMBER (01) | CA |