Basic Information
| Provider Information | |||||||||
| NPI: | 1306049416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIAMINGO | ||||||||
| FirstName: | MARY ANN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1177 AVALON DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951254218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082656144 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 S BASCOM AVE | ||||||||
| Address2: | DIABETES ED | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088855000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN1003X | RN262901 | CA | Y | Nursing Service Providers | Registered Nurse | Nutrition Support |
No ID Information.