Provider Demographics
NPI:1457996258
Name:KING, MARGARITA L (MSN, PHN, RN)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:MSN, PHN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 HIGHWAY 49 NORTH (POST OFFICE BOX 5)
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338
Mailing Address - Country:US
Mailing Address - Phone:209-966-3689
Mailing Address - Fax:209-966-4929
Practice Address - Street 1:5300 HIGHWAY 49 NORTH
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-3689
Practice Address - Fax:209-966-4929
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN444330163WA2000X, 163W00000X
CA66282261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local