Provider Demographics
NPI:1033957576
Name:MAINA, CECILIA W (LVN)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:W
Last Name:MAINA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 WINGED FOOT DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-8001
Mailing Address - Country:US
Mailing Address - Phone:443-600-3563
Mailing Address - Fax:
Practice Address - Street 1:10045 WINGED FOOT DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-8001
Practice Address - Country:US
Practice Address - Phone:443-600-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA744093164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse