Provider Demographics
NPI:1639555691
Name:MALASAN, MARIA THERESA MADUENO (NP)
Entity Type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:MADUENO
Last Name:MALASAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1634
Mailing Address - Country:US
Mailing Address - Phone:707-315-0710
Mailing Address - Fax:
Practice Address - Street 1:138 EAGLE CT
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1634
Practice Address - Country:US
Practice Address - Phone:707-315-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily