Healthcare Provider Details

I. General information

NPI: 1255885034
Provider Name (Legal Business Name): ASHLEY EAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PARKMOOR AVE
SAN JOSE CA
95126-3797
US

IV. Provider business mailing address

967 TWIN BROOK DR
SAN JOSE CA
95126-4068
US

V. Phone/Fax

Practice location:
  • Phone: 408-510-3480
  • Fax:
Mailing address:
  • Phone: 408-409-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: