Provider Demographics
NPI:1578924114
Name:SURIO, BLESILDA MANIEGO (RN)
Entity Type:Individual
Prefix:
First Name:BLESILDA
Middle Name:MANIEGO
Last Name:SURIO
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 1:1220 MORELLO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4707
Mailing Address - Country:US
Mailing Address - Phone:925-957-2616
Mailing Address - Fax:
Practice Address - Street 1:1220 MORELLO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4707
Practice Address - Country:US
Practice Address - Phone:925-957-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477064163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator