Provider Demographics
NPI:1417645326
Name:PAJARILLO, REYMAVIL (CM, UM)
Entity Type:Individual
Prefix:
First Name:REYMAVIL
Middle Name:
Last Name:PAJARILLO
Suffix:
Gender:F
Credentials:CM, UM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5159
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5159
Mailing Address - Country:US
Mailing Address - Phone:562-833-4074
Mailing Address - Fax:
Practice Address - Street 1:5829 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1001
Practice Address - Country:US
Practice Address - Phone:424-429-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
126800000X
CAVN253796171M00000X, 364S00000X, 364SH0200X, 364SL0600X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No126800000XDental ProvidersDental Assistant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care