Provider Demographics
NPI:1952483133
Name:VALMIDIANO-WILSON, MARIA T (CRNA, MSN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:VALMIDIANO-WILSON
Suffix:
Gender:F
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:TERESA RODRIGUEZ
Other - Last Name:VALMIDIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:ANESTHESIOLOGY
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:11845 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6825
Practice Address - Country:US
Practice Address - Phone:562-809-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445909163W00000X
CA000000NA2417367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB265761Medicare PIN