Healthcare Provider Details

I. General information

NPI: 1003350042
Provider Name (Legal Business Name): LASHONDA RENEA EAGELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 UNION AVE
SAN JOSE CA
95124-2009
US

IV. Provider business mailing address

PO BOX 720923
SAN JOSE CA
95172-0923
US

V. Phone/Fax

Practice location:
  • Phone: 408-371-0960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97406
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number97406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: