Healthcare Provider Details

I. General information

NPI: 1922505130
Provider Name (Legal Business Name): EUNICE TAPIA DIAZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

27444 CAMDEN APT 17J
MISSION VIEJO CA
92692-3320
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-7991
  • Fax:
Mailing address:
  • Phone: 951-203-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95072643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: