Provider Demographics
NPI:1184796583
Name:ENCARNACION, MARILOU C (PNP)
Entity type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:C
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:PNP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 NORTH PEPPER AVE
Mailing Address - Street 2:6TH FLOOR ADMINISTRATIVE OFFICE PEDIAT
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1819
Mailing Address - Country:US
Mailing Address - Phone:909-580-6315
Mailing Address - Fax:909-580-6361
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1818
Practice Address - Country:US
Practice Address - Phone:909-580-6315
Practice Address - Fax:909-580-6361
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA16126208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics