Provider Demographics
NPI:1689817165
Name:MARESCA, LILLIANA PATRICIA (240713)
Entity Type:Individual
Prefix:
First Name:LILLIANA
Middle Name:PATRICIA
Last Name:MARESCA
Suffix:
Gender:F
Credentials:240713
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 E LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3940
Mailing Address - Country:US
Mailing Address - Phone:805-577-0830
Mailing Address - Fax:805-582-4808
Practice Address - Street 1:3150 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3940
Practice Address - Country:US
Practice Address - Phone:805-577-0830
Practice Address - Fax:805-582-4808
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240713164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse