Provider Demographics
NPI:1396257275
Name:NEPOMUCENO, FELICIA ROSE (AUD)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:ROSE
Last Name:NEPOMUCENO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 PENNSYLVANIA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3509
Mailing Address - Country:US
Mailing Address - Phone:707-426-4327
Mailing Address - Fax:707-446-5307
Practice Address - Street 1:1620 PENNSYLVANIA AVE STE D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3509
Practice Address - Country:US
Practice Address - Phone:707-426-4327
Practice Address - Fax:707-446-5307
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9686237700000X
CA3251231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist