Healthcare Provider Details

I. General information

NPI: 1225584584
Provider Name (Legal Business Name): LEYDIS MARLEN EAWAZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEYDIS MARLEN VARONA ARNP

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2371 OWEN ST
SANTA CLARA CA
95054-3212
US

IV. Provider business mailing address

1063 POMEROY AVE
SANTA CLARA CA
95051-4406
US

V. Phone/Fax

Practice location:
  • Phone: 408-708-0204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9337001
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: