Provider Demographics
NPI:1093366726
Name:PRECIADO, MAYRA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 ROJA ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-4317
Mailing Address - Country:US
Mailing Address - Phone:760-472-9527
Mailing Address - Fax:
Practice Address - Street 1:431 SHADOW TREE DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7022
Practice Address - Country:US
Practice Address - Phone:760-362-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD9588865OtherDRIVER LICENSE