Provider Demographics
NPI:1134728538
Name:TAVERA, AIMEE PAYUMO (RN)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:PAYUMO
Last Name:TAVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:AIMEE
Other - Middle Name:UMALI
Other - Last Name:PAYUMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4422 42ND ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4789
Mailing Address - Country:US
Mailing Address - Phone:347-337-2471
Mailing Address - Fax:
Practice Address - Street 1:1075 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3538
Practice Address - Country:US
Practice Address - Phone:619-881-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663558163W00000X
CA95208672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse