Provider Demographics
NPI:1194069328
Name:MARES, DEANNA MARIE (LVN)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MARIE
Last Name:MARES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-4135
Mailing Address - Country:US
Mailing Address - Phone:805-814-3559
Mailing Address - Fax:
Practice Address - Street 1:3825 SUNSET LN
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-4135
Practice Address - Country:US
Practice Address - Phone:805-814-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236404164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse