Provider Demographics
NPI:1083858401
Name:CABALTICA, MITZI LLAMAS (RN)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:LLAMAS
Last Name:CABALTICA
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 1:1359 S. WALNUT ST. # 5025
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802
Mailing Address - Country:US
Mailing Address - Phone:714-463-0811
Mailing Address - Fax:
Practice Address - Street 1:1359 S WALNUT ST
Practice Address - Street 2:# 5025
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2260
Practice Address - Country:US
Practice Address - Phone:714-463-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608759163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health