Provider Demographics
NPI:1063246379
Name:LAUREL, MARICAR
Entity type:Individual
Prefix:
First Name:MARICAR
Middle Name:
Last Name:LAUREL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9063 CHIANTI CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3816
Mailing Address - Country:US
Mailing Address - Phone:209-688-8058
Mailing Address - Fax:888-927-7518
Practice Address - Street 1:9063 CHIANTI CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-3816
Practice Address - Country:US
Practice Address - Phone:209-688-8058
Practice Address - Fax:888-927-7518
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392700941311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home