Provider Demographics
NPI:1154667756
Name:TANJUAQUIO, LIAH FERDELIZ DE JESUS (RN)
Entity Type:Individual
Prefix:MRS
First Name:LIAH FERDELIZ
Middle Name:DE JESUS
Last Name:TANJUAQUIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LIAH FERDELIZ
Other - Middle Name:MENDOZA
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1370 DUSTIN DR UNIT 11
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2741
Mailing Address - Country:US
Mailing Address - Phone:818-486-8271
Mailing Address - Fax:
Practice Address - Street 1:1370 DUSTIN DR UNIT 11
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2741
Practice Address - Country:US
Practice Address - Phone:818-486-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN767070163W00000X, 163WC0400X, 163WH0200X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation