Provider Demographics
NPI:1700375177
Name:LAJON-DIMALANTA, THELMA HERANA (RN)
Entity Type:Individual
Prefix:MRS
First Name:THELMA
Middle Name:HERANA
Last Name:LAJON-DIMALANTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BISSO LN STE D1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4832
Mailing Address - Country:US
Mailing Address - Phone:925-608-6760
Mailing Address - Fax:
Practice Address - Street 1:2400 BISSO LN STE D1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-608-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA668560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty