Provider Demographics
NPI:1639220817
Name:LAU, CECILIA CARMEN
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:CARMEN
Last Name:LAU
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 1:1497 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2916
Mailing Address - Country:US
Mailing Address - Phone:951-427-1216
Mailing Address - Fax:
Practice Address - Street 1:1497 HILLTOP LN
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2916
Practice Address - Country:US
Practice Address - Phone:951-427-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN153302164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse