Healthcare Provider Details

I. General information

NPI: 1154808368
Provider Name (Legal Business Name): DIANA MARCELA EATON MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

IV. Provider business mailing address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4353
  • Fax:
Mailing address:
  • Phone: 831-454-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15197-13
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: