Provider Demographics
NPI:1861711780
Name:LAROZA, NENA B
Entity type:Individual
Prefix:
First Name:NENA
Middle Name:B
Last Name:LAROZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15237 CALLE JUANITO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1010
Mailing Address - Country:US
Mailing Address - Phone:858-672-0409
Mailing Address - Fax:858-672-0409
Practice Address - Street 1:15237 CALLE JUANITO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1010
Practice Address - Country:US
Practice Address - Phone:858-672-0409
Practice Address - Fax:858-672-0409
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374602831177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA374602831Medicaid