Provider Demographics
NPI:1154957769
Name:DUMLAO, MAYBEL DEGUZMAN
Entity type:Individual
Prefix:
First Name:MAYBEL
Middle Name:DEGUZMAN
Last Name:DUMLAO
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 1:4371 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6133
Mailing Address - Country:US
Mailing Address - Phone:646-385-6344
Mailing Address - Fax:
Practice Address - Street 1:4371 STEWART AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6133
Practice Address - Country:US
Practice Address - Phone:646-385-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily