Healthcare Provider Details

I. General information

NPI: 1194642793
Provider Name (Legal Business Name): ELIANA POL WEDEMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 CHRONICLE AVE
HAYWARD CA
94542-2010
US

IV. Provider business mailing address

3074 CHRONICLE AVE
HAYWARD CA
94542-2010
US

V. Phone/Fax

Practice location:
  • Phone: 925-389-8234
  • Fax:
Mailing address:
  • Phone: 925-389-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number95093259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: