Provider Demographics
NPI:1205303831
Name:WEGER, CEZARIA KIMMAYONG
Entity type:Individual
Prefix:
First Name:CEZARIA
Middle Name:KIMMAYONG
Last Name:WEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-0608
Mailing Address - Country:US
Mailing Address - Phone:619-253-6924
Mailing Address - Fax:
Practice Address - Street 1:7922 PALM ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2956
Practice Address - Country:US
Practice Address - Phone:619-644-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN690667164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse