Provider Demographics
NPI:1891245536
Name:CATALAN, MARIA LIRA CASTILLO (RN)
Entity Type:Individual
Prefix:
First Name:MARIA LIRA
Middle Name:CASTILLO
Last Name:CATALAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIA LIRA
Other - Middle Name:CATALAN
Other - Last Name:BUNAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8723 KINGSTON PL APT 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4647
Mailing Address - Country:US
Mailing Address - Phone:917-488-4881
Mailing Address - Fax:
Practice Address - Street 1:8723 KINGSTON PL APT 1
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4647
Practice Address - Country:US
Practice Address - Phone:917-488-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY722159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY722159OtherBOARD OF NURSING RN