Provider Demographics
NPI:1952943086
Name:VITUG, MARIA GRATIANA (LVN)
Entity Type:Individual
Prefix:
First Name:MARIA GRATIANA
Middle Name:
Last Name:VITUG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:GRATIANA
Other - Middle Name:
Other - Last Name:VITUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 ALLEN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 ALLEN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:669-308-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA731890164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse