Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95001777 | CA |
NPI | 1003207739 |
---|---|
Provider Name | Mrs. Maria Araceli Berumen |
First Address | Los Angeles, CA 90059 |
Second Address | Los Angeles, CA 90059-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2015 |
Last Update Date | 04/01/2018 |