Provider Demographics
NPI:1255047007
Name:JAUCIAN, MARISTELA MONTERO (RN)
Entity type:Individual
Prefix:
First Name:MARISTELA
Middle Name:MONTERO
Last Name:JAUCIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARISTELA
Other - Middle Name:GEYROZAGA
Other - Last Name:MONTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:218 SILVER BELL WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-2344
Mailing Address - Country:US
Mailing Address - Phone:925-628-4207
Mailing Address - Fax:
Practice Address - Street 1:218 SILVER BELL WAY
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-2344
Practice Address - Country:US
Practice Address - Phone:925-628-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95076123163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse