Healthcare Provider Details

I. General information

NPI: 1881706380
Provider Name (Legal Business Name): EUREKA PEDIATRICS MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 HARRIS ST
EUREKA CA
95503-4809
US

IV. Provider business mailing address

2800 HARRIS ST
EUREKA CA
95503-4809
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8416
  • Fax: 707-445-4182
Mailing address:
  • Phone: 707-445-8416
  • Fax: 707-445-4182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. ELESHA L HERNANDEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 707-445-8416