Provider Demographics
NPI:1609665439
Name:MAYEN, ROCIO Y
Entity type:Individual
Prefix:MS
First Name:ROCIO
Middle Name:Y
Last Name:MAYEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 HOLLISTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3616
Mailing Address - Country:US
Mailing Address - Phone:818-721-1303
Mailing Address - Fax:
Practice Address - Street 1:1040 HOLLISTER ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3616
Practice Address - Country:US
Practice Address - Phone:818-721-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN713612374T00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel