Healthcare Provider Details

I. General information

NPI: 1912837634
Provider Name (Legal Business Name): CAROLINA EUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 G ST
CHULA VISTA CA
91910-3604
US

IV. Provider business mailing address

1238 ORDE CT
CHULA VISTA CA
91911-3014
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-8374
  • Fax:
Mailing address:
  • Phone: 619-909-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: