Individual
MARITZA FOMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9808 VENICE BLVD, SUITE 700, CULVER CITY, CA 90232-2732
(310) 253-9494
(310) 253-9495
Mailing address
9808 VENICE BLVD, SUITE 700, CULVER CITY, CA 90232-2732
(310) 253-9494
(310) 253-9495
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
481787
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
481787
REGISTERED NURSING LIC
CA
Enumeration date
07/02/2007
Last updated
07/08/2007
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