Individual
MS. MARIDOL MACIAS BERCILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
6101 N TOWER LN APT A, PRESCOTT VALLEY, AZ 86314-3198
(909) 856-7717
Mailing address
6101 N TOWER LN APT A, PRESCOTT VALLEY, AZ 86314-3198
(909) 856-7717
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
273763
CA
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
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