Provider Demographics
NPI:1386400133
Name:MAISURIA, NENCY SURESHKUMAR
Entity type:Individual
Prefix:
First Name:NENCY
Middle Name:SURESHKUMAR
Last Name:MAISURIA
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 1:12016 IMPERIAL HWY APT 3
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3009
Mailing Address - Country:US
Mailing Address - Phone:925-505-1519
Mailing Address - Fax:
Practice Address - Street 1:12016 IMPERIAL HWY APT 3
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3009
Practice Address - Country:US
Practice Address - Phone:925-505-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist