Provider Demographics
NPI:1558446781
Name:MAILLEFER, NANCY T (PHARMD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:T
Last Name:MAILLEFER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1445
Mailing Address - Country:US
Mailing Address - Phone:714-436-4444
Mailing Address - Fax:
Practice Address - Street 1:1665 SCENIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1443
Practice Address - Country:US
Practice Address - Phone:714-436-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41171208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41171Medicaid