Provider Demographics
NPI:1003033549
Name:OVERTON, MARYANN (CCP)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10743 S BLANEY AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4543
Mailing Address - Country:US
Mailing Address - Phone:408-255-4018
Mailing Address - Fax:650-615-9995
Practice Address - Street 1:10743 S BLANEY AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4543
Practice Address - Country:US
Practice Address - Phone:408-255-4018
Practice Address - Fax:650-615-9995
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770067242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist