Provider Demographics
NPI:1720868169
Name:MANCERA, MARIA EUGENIA (LVN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EUGENIA
Last Name:MANCERA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 TWEEDY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6359
Mailing Address - Country:US
Mailing Address - Phone:323-825-8300
Mailing Address - Fax:866-372-2719
Practice Address - Street 1:4476 TWEEDY BLVD STE B
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6359
Practice Address - Country:US
Practice Address - Phone:323-825-8300
Practice Address - Fax:866-372-2719
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206984164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse