Provider Demographics
NPI:1992387906
Name:HOWARD, MARY GEORGEEN (CNA,)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GEORGEEN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:CNA,
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GEORGEEN
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:17325 DE GROOT PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1122
Mailing Address - Country:US
Mailing Address - Phone:562-706-4877
Mailing Address - Fax:
Practice Address - Street 1:17325 DE GROOT PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1122
Practice Address - Country:US
Practice Address - Phone:562-706-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00807947376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide