Provider Demographics
NPI:1285146977
Name:ADRIANO, MAE KHRISTINE UBALDO (CPNP)
Entity type:Individual
Prefix:
First Name:MAE KHRISTINE
Middle Name:UBALDO
Last Name:ADRIANO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15109 TUBA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2734
Mailing Address - Country:US
Mailing Address - Phone:310-963-1589
Mailing Address - Fax:
Practice Address - Street 1:12540 PIERCE ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1701
Practice Address - Country:US
Practice Address - Phone:818-897-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007620363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics