Provider Demographics
NPI:1558726760
Name:OCEGUERA-RIOS, MIRIAM (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:OCEGUERA-RIOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CANAL FARM LN APT B11
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3800
Mailing Address - Country:US
Mailing Address - Phone:209-704-0209
Mailing Address - Fax:
Practice Address - Street 1:14425 G STREET
Practice Address - Street 2:
Practice Address - City:SNELLING
Practice Address - State:CA
Practice Address - Zip Code:95369
Practice Address - Country:US
Practice Address - Phone:209-678-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279983164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse