MS. MARIA CHARISMA SIDECO LICERALDE (NPI# 1134307507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134307507 |
| Entity Type | Individual |
| Full Name | MS. MARIA CHARISMA SIDECO LICERALDE |
| Credential | APRN, PMHNP, BC |
| Practice Address |
80 Great Oaks Blvd San Jose CA 95119-1310 |
| Practice Telephone | 4083633000 |
| Practice Fax Number | 4083633046 |
| Mailing Telephone | 4083633000 |
| Mailing Fax Number | 4083633046 |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2008-02-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
715901 | CA | Nursing Service Providers |
| Street Address |
80 GREAT OAKS BLVD |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95119-1310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609844729 | Marion Jean Hogan | Nurse Practitioner | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2006-03-14 |
| 1033631205 | Nichole E Imamura-sperling | Social Worker | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2017-07-10 |
| 1326570706 | Joanna Michaels | Social Worker | 80 Great Oaks Blvd, B-209, San Jose, CA 95119-1310 | 2017-04-03 |
| 1184176752 | Linda Woodsmall | Social Worker | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2016-10-31 |
| 1053786780 | Patricia Ann Ash Moore | Social Worker | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2015-12-07 |
| 1457721128 | Russell Schnurr | Social Worker | 80 Great Oaks Blvd, 180d, San Jose, CA 95119-1310 | 2015-10-06 |
| 1003206244 | Va Palo Alto Healthcare System | Clinic/Center | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2015-01-26 |
| 1700284932 | Thanh Nga Thi Do | Social Worker | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2014-12-22 |
| 1417387002 | Va | Psychiatric Unit | 80 Great Oaks Blvd, San Jose, CA 95119 | 2013-11-18 |
| 1295099331 | Angel Yu | Pharmacist | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2012-07-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922623594 | Julia Angelina Rojas | Rehabilitation Counselor | 298 A Bernal Rd, San Jose, CA 95119 | 2020-06-10 |
| 1609496215 | Kaiser Foundation Hospitals | Pharmacy | 274 International Cir Fl 1 Rm 104, San Jose, CA 95119 | 2020-04-23 |
| 1104451194 | Arthur Warren Hall | Counselor | 298 A Bernal Road, San Jose, CA 95119 | 2020-03-10 |
| 1992264774 | Jennifer Luu | Student in an Organized Health Care Education/Training Program | 276 International Circle Building, 1 - 2nd Floor - Family Medicine Residency Unit G, San Jose, CA 95119 | 2019-03-19 |
| 1194209510 | Victoria Marques | Pharmacist | 275 Hospital Parkway, Suite 625, San Jose, CA 95119 | 2018-09-21 |
| 1780123497 | Costco Wholesale Corporation | Hearing Aid Equipment | 6898 Raleigh Road, San Jose, CA 95119 | 2017-02-14 |
| 1437563855 | Mark Douglas Zukunft | Emergency Medicine | 250 Hospital Pkwy Dept Of, San Jose, CA 95119 | 2014-06-13 |
| 1669896338 | Paul J. Zuchowski Chiropractic, A Professional Corporation | Chiropractor | 6950 Santa Teresa Blvd., Ste.a, San Jose, CA 95119 | 2014-02-14 |
| 1700227873 | Yu-chien Cheng | Internal Medicine | 275 Hospital Pkwy Ste 600, San Jose, CA 95119 | 2013-07-17 |
| 1730432014 | Tami Otomo | Pharmacist | 6201 San Ignacio Ave, San Jose, CA 95119 | 2012-10-24 |
| Find all providers in zip 95119 | ||||
| Taxonomy Code | 163WP0809X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health, Adult |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891356671 | Alan Le | Registered Nurse | 298 Bernal Rd, San Jose, CA 95119-1809 | 2019-06-24 |
| 1235648536 | Nga Tuyet Dang | Registered Nurse | 2001 The Alameda, San Jose, CA 95126-1136 | 2017-09-29 |
| 1962923524 | Jess Laraza Reyes | Registered Nurse | 2001 The Alameda, San Jose, CA 95126-1136 | 2017-07-04 |
| 1043584816 | Kevin Austin Mckellar | Registered Nurse | 2001 The Alameda, San Jose, CA 95126-1136 | 2012-02-26 |
| 1588686364 | David Sisson | Registered Nurse | 80 Great Oaks Blvd, San Jose, CA 95119-1310 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033739677 | Tiffany Venice Turner | Registered Nurse | 2085 Rustin Ave Bldg 5, Riverside, CA 92507-2498 | 2020-04-23 |
| 1073144549 | Cedelia Untalan Cardenas | Registered Nurse | 17053 Foothill Blvd Bldg N, Fontana, CA 92335-3574 | 2020-02-03 |
| 1689204265 | Juvelyn Isip Ingal | Registered Nurse | 3853 Rosecrans St # Ca92110, San Diego, CA 92110-3115 | 2020-01-22 |
| 1043859531 | Klair Grace | Registered Nurse | 6460 Convoy Ct Spc 115, San Diego, CA 92117-2314 | 2019-12-31 |
| 1316588395 | Batoul Salameh | Registered Nurse | 19204 Bension Dr, Santa Clarita, CA 91350-3797 | 2019-10-01 |
| 1851949580 | Michael Perez | Registered Nurse | 25727 Mcbean Pkwy, Valencia, CA 91355-3704 | 2019-08-27 |
| 1982259792 | Beverly Austin Mccabe | Registered Nurse | 1720 E. Cesar Chavez Ave., Los Angeles, CA 90033 | 2019-08-08 |
| 1396390530 | Trisha Lynne Basman | Registered Nurse | 939 Snow Dr, Martinez, CA 94553-4715 | 2019-08-05 |
| 1003378043 | Ildefonso Silva Rodriguez | Registered Nurse | 2437 Woodcreek Rd, Camarillo, CA 93012-2537 | 2019-04-01 |
| 1518430842 | Jesus Lim | Registered Nurse | 695 Sea Vale St Unit 202, Chula Vista, CA 91910-1242 | 2019-01-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.