Provider Demographics
NPI:1114596236
Name:MAURICIO-HALAGAO, MARIA RICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:MARIA RICHELLE
Middle Name:
Last Name:MAURICIO-HALAGAO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 ASTOR AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5435
Mailing Address - Country:US
Mailing Address - Phone:917-605-2777
Mailing Address - Fax:
Practice Address - Street 1:1170 ASTOR AVE APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5435
Practice Address - Country:US
Practice Address - Phone:917-605-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34146201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse