Provider Demographics
NPI:1073806741
Name:NACION-ANDERSON, EDNA QUIAMBAO (RN)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:QUIAMBAO
Last Name:NACION-ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 ANACAPA DR. #107
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6834
Mailing Address - Country:US
Mailing Address - Phone:714-612-6303
Mailing Address - Fax:714-979-3624
Practice Address - Street 1:2553 ANACAPA DR. #107
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6834
Practice Address - Country:US
Practice Address - Phone:714-612-6303
Practice Address - Fax:714-979-3624
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL036099343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)