Provider Demographics
NPI:1972389435
Name:HERBAS, MAUREEN MAY TECSON
Entity Type:Individual
Prefix:
First Name:MAUREEN MAY
Middle Name:TECSON
Last Name:HERBAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 VIA REAL UNIT 99
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-2614
Mailing Address - Country:US
Mailing Address - Phone:805-450-6883
Mailing Address - Fax:
Practice Address - Street 1:US 191 AZ 264
Practice Address - Street 2:SAGE MEMORIAL HOSPITAL
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95334189163W00000X
AZ254500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse