Provider Demographics
NPI:1205646221
Name:UBALDO, MARIA DIVINA (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIA DIVINA
Middle Name:
Last Name:UBALDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S LIVERMORE AVE UNIT 143
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4636
Mailing Address - Country:US
Mailing Address - Phone:925-436-0951
Mailing Address - Fax:
Practice Address - Street 1:220 S LIVERMORE AVE UNIT 143
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4636
Practice Address - Country:US
Practice Address - Phone:925-436-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033390363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner