Provider Demographics
NPI:1134597321
Name:BUNDALIAN, MAILA SUCALDITO (RN)
Entity type:Individual
Prefix:MRS
First Name:MAILA
Middle Name:SUCALDITO
Last Name:BUNDALIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32864 BACHELOR PEAK STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-5201
Mailing Address - Country:US
Mailing Address - Phone:951-219-5975
Mailing Address - Fax:
Practice Address - Street 1:32864 BACHELOR PEAK STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-5201
Practice Address - Country:US
Practice Address - Phone:951-219-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507513163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse