Provider Demographics
NPI:1669941159
Name:PLASENCIA, MARIA LUISA (RN)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LUISA
Last Name:PLASENCIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4947 PERCEPTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-3631
Mailing Address - Country:US
Mailing Address - Phone:916-812-2341
Mailing Address - Fax:
Practice Address - Street 1:MARTIN LUTHER KING JR. TECHNOLOGY ACADEMY
Practice Address - Street 2:3051 FAIRFIELD ST
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815
Practice Address - Country:US
Practice Address - Phone:916-566-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527828163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse