Provider Demographics
NPI:1598189094
Name:MONERO, MALIACA
Entity Type:Individual
Prefix:
First Name:MALIACA
Middle Name:
Last Name:MONERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18353 BRINKERHOFF AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1901
Mailing Address - Country:US
Mailing Address - Phone:347-472-9800
Mailing Address - Fax:
Practice Address - Street 1:18353 BRINKERHOFF AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1901
Practice Address - Country:US
Practice Address - Phone:347-472-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316963164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse