Provider Demographics
NPI:1821560178
Name:PAYUMO, MARIA HOSSANAH SALES (MSN, RN CCRN-K)
Entity Type:Individual
Prefix:
First Name:MARIA HOSSANAH
Middle Name:SALES
Last Name:PAYUMO
Suffix:
Gender:F
Credentials:MSN, RN CCRN-K
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3710
Mailing Address - Country:US
Mailing Address - Phone:818-913-4200
Mailing Address - Fax:
Practice Address - Street 1:3029 HERMOSA AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3710
Practice Address - Country:US
Practice Address - Phone:818-913-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA692069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily