Healthcare Provider Details

I. General information

NPI: 1912986944
Provider Name (Legal Business Name): JACQUELINE A EUBANY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E KATELLA AVE STE B
ORANGE CA
92867-4857
US

IV. Provider business mailing address

438 E KATELLA AVE STE B
ORANGE CA
92867-4857
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-5000
  • Fax: 714-744-5985
Mailing address:
  • Phone: 714-744-5000
  • Fax: 714-744-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101242737
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMED-PHYS-LIC-129127
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number10038A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA134183
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number81736-20
License Number StateWI
# 6
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number70735
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: