Provider Demographics
NPI:1619189321
Name:LOO-MARTINEZ, MAUREEN IWALANI (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:IWALANI
Last Name:LOO-MARTINEZ
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 ROSECRANS STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92186-5222
Mailing Address - Country:US
Mailing Address - Phone:619-692-8808
Mailing Address - Fax:
Practice Address - Street 1:3851 ROSECRANS STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92186-5222
Practice Address - Country:US
Practice Address - Phone:619-692-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565818163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health