Gereine Mae Condino Datan
Nurse Practitioner in Gardena, CA. Individual provider (NPI-1).
NPI number1215537543
StatusActive
Last updated in NPPESOct 27, 2020
Details
- NPI
- 1215537543
- Entity type
- Individual (NPI-1)
- Name
- Gereine Mae Condino Datan
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 27, 2020
- Certification date
- Oct 26, 2020
- Last updated
- Oct 27, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | F08201140 | CA | Yes |
Practice location
500 W 190 StGardena, CA 90248
Phone 714-452-1961
Mailing address
25612 Barton Rd # 290Loma Linda, CA 92354-3110
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