Provider Demographics
NPI:1912306523
Name:CARREON-TANALA, MARILYN (RN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:CARREON-TANALA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:BEBIT
Other - Last Name:CARREON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12622 PECOS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2514
Mailing Address - Country:US
Mailing Address - Phone:562-569-2928
Mailing Address - Fax:
Practice Address - Street 1:12622 PECOS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2514
Practice Address - Country:US
Practice Address - Phone:562-569-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558394163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse