Basic Information
| Provider Information | |||||||||
| NPI: | 1265675995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUCANAN | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | CARMELA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 SANTIAGO LN | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945261976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256398106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 TAYLOR BLVD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945232147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258258878 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2009 | ||||||||
| LastUpdateDate: | 08/30/2013 | ||||||||
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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 | 363LG0600X | 18662 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.