Provider Demographics
NPI:1851600936
Name:MAVARES, IMELDA (CERTIFIED HEALTH AID)
Entity Type:Individual
Prefix:MS
First Name:IMELDA
Middle Name:
Last Name:MAVARES
Suffix:
Gender:F
Credentials:CERTIFIED HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13472 WILLAMETTE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-2537
Mailing Address - Country:US
Mailing Address - Phone:714-209-7705
Mailing Address - Fax:714-209-7653
Practice Address - Street 1:13472 WILLAMETTE DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-2537
Practice Address - Country:US
Practice Address - Phone:714-209-7705
Practice Address - Fax:714-209-7653
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA089897374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide