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Individual

MS. MARIA MARTA VIRI RENOLAYAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
3325 PALO VERDE AVE STE 203, LONG BEACH, CA 90808-4132
(562) 421-8283
Mailing address
555 PAULARINO AVE APT L105, COSTA MESA, CA 92626-3280
(562) 881-5127

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95010961
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95010961
BOARD OF REGISTERED NURSING
CA
Enumeration date
03/22/2019
Last updated
03/22/2019
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