Provider Demographics
NPI:1104687011
Name:POSADAS, DEMETRIA (PMNNP-BC)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:POSADAS
Suffix:
Gender:F
Credentials:PMNNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WILSHIRE BLVD APT 408
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5770
Mailing Address - Country:US
Mailing Address - Phone:562-342-0566
Mailing Address - Fax:
Practice Address - Street 1:2112 E 4TH ST STE 228A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3840
Practice Address - Country:US
Practice Address - Phone:562-342-0566
Practice Address - Fax:562-501-3790
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028293363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health