Miriam Avena-Mascareno, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95021379 Issued in CA

Practice address

1179 N McDowell Blvd
Petaluma, CA 94954-6559

Phone

(707) 559-7500

NPI assigned

Aug 25, 2022

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Petaluma Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
  • NPI 1588656268
  NPD (past)
• Petaluma Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Rohnert Park, CA
  • NPI 1669870739
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: mavenamascareno614115@direct.ochin.org

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 13, 2023.

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1629797246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVENA-MASCARENO",
        "first_name": "MIRIAM",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-25",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95021379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashton L. Atkins
• Corriene Atup, BSPT
• Veronique L Au, MD
• Lindsay A Autio, MD
• Esperanza Avalos, LMT
• Sara Lynn Avery, MFT
• Michael Andrew Aviles
• Francene R Ayala
• Yasaman Ayat
• Saw Wynn Aye, M.D

• All providers in Petaluma, CA
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.