Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 262550 | CA |
NPI | 1053535740 |
---|---|
Provider Name | Patricia Cresto |
First Address | Ventura, CA 93003-3099 |
Second Address | Ventura, CA 93003-3099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |