Provider Demographics
NPI:1801002704
Name:KING, MARIA ANGELA (CNM, RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ANGELA
Last Name:KING
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 BLACK PEARL CT
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-4405
Mailing Address - Country:US
Mailing Address - Phone:714-470-1506
Mailing Address - Fax:
Practice Address - Street 1:1881 BUSINESS CENTER DR STE 8A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3448
Practice Address - Country:US
Practice Address - Phone:714-470-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615636163WL0100X, 2085U0001X
CA1593163WM0102X, 163WN0003X, 163WP1700X, 163WW0101X, 367A00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-RiskGroup - Single Specialty
No163WP1700XNursing Service ProvidersRegistered NursePerinatalGroup - Single Specialty
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12646542OtherCAQH PROVIDER ID