Provider Demographics
NPI:1134958127
Name:FRAUSTO, MARIA GUADALUPE (LVN)
Entity type:Individual
Prefix:
First Name:MARIA GUADALUPE
Middle Name:
Last Name:FRAUSTO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LUPE
Other - Last Name:FRAUSTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:10021 FORRESTAL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3717
Mailing Address - Country:US
Mailing Address - Phone:714-800-0407
Mailing Address - Fax:
Practice Address - Street 1:12781 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4622
Practice Address - Country:US
Practice Address - Phone:714-606-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288558164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse