| Doctor Name: | MS. MARIANA CONCEPCION MOUALEM |
| NPI Number: | 1003187915 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 21556 |
| Business Practice Address: | 2015 West First Street Suite L Santa Ana, CA - 927033516 |
| Business Phone Number: | 7145477745 |
| Business Fax Number: | 7145476502 |
| Mailing Address: | 908 North Ardmore Ave, LOS ANGELES |
| State: | CA |
| Postal Code: | 90029 |
| Phone Number: | 6266328795 |
| Fax Number: | |
| NPI Enumeration Date: | 01/24/2012 |
| NPI Last Update Date: | 01/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 21556 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |