Provider Demographics
NPI:1669943155
Name:CID, MARIELENA (RN, CDE)
Entity type:Individual
Prefix:
First Name:MARIELENA
Middle Name:
Last Name:CID
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DRIVE
Mailing Address - Street 2:PROBST 100-B
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3227
Mailing Address - Country:US
Mailing Address - Phone:760-837-8718
Mailing Address - Fax:760-773-1880
Practice Address - Street 1:39000 BOB HOPE DRIVE
Practice Address - Street 2:PROBST BLDG. 100B
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-837-8718
Practice Address - Fax:760-773-1880
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator