Provider Demographics
NPI:1710280961
Name:ERMAKOV, MARICEL (RN)
Entity Type:Individual
Prefix:MS
First Name:MARICEL
Middle Name:
Last Name:ERMAKOV
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 1:655 PARK CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-6957
Mailing Address - Country:US
Mailing Address - Phone:619-596-5500
Mailing Address - Fax:
Practice Address - Street 1:655 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6957
Practice Address - Country:US
Practice Address - Phone:619-596-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA766227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse