Provider Demographics
NPI:1760662605
Name:MARANTOS, ALEXIS A (LVN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:MARANTOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 BLAINE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3379
Mailing Address - Country:US
Mailing Address - Phone:951-358-4705
Mailing Address - Fax:951-358-4719
Practice Address - Street 1:769 BLAINE ST
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-358-4705
Practice Address - Fax:951-358-4719
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227150164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse