1134865207 NPI number — MAUREEN MONROY NELSON CPNP-PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134865207 NPI number — MAUREEN MONROY NELSON CPNP-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
MAUREEN
Provider Middle Name:
MONROY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP-PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONROY
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
BELINDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134865207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2125 E. THOUSAND OAKS BLVD, SUITE B-2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91362-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-374-7874
Provider Business Mailing Address Fax Number:
805-374-7876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2125 E. THOUSAND OAKS BLVD, SUITE B-2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91362-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-374-7874
Provider Business Practice Location Address Fax Number:
805-374-7876
Provider Enumeration Date:
05/11/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0200X , with the licence number:  4840 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 95012666 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)