Provider Demographics
NPI:1942550884
Name:NATIVIDAD, MAUREEN R (MAUREEN NATIVIDAD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:R
Last Name:NATIVIDAD
Suffix:
Gender:F
Credentials:MAUREEN NATIVIDAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17619 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3510
Mailing Address - Country:US
Mailing Address - Phone:818-334-0374
Mailing Address - Fax:
Practice Address - Street 1:17619 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3510
Practice Address - Country:US
Practice Address - Phone:818-334-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist