Provider Demographics
NPI:1174839898
Name:ROMA, AGLAIA BLANCA CUESTA (RN)
Entity Type:Individual
Prefix:
First Name:AGLAIA BLANCA
Middle Name:CUESTA
Last Name:ROMA
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 1:7447 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1631
Mailing Address - Country:US
Mailing Address - Phone:818-787-3400
Mailing Address - Fax:
Practice Address - Street 1:7447 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1631
Practice Address - Country:US
Practice Address - Phone:818-787-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA774335163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse