Healthcare Provider Details

I. General information

NPI: 1487105243
Provider Name (Legal Business Name): EILEEN MAY NEPOMUCENO BARRAZA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN NEPOMUCENO N.P.

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S HARBOR BLVD
SANTA ANA CA
92704-6919
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 714-929-2300
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005169
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95005169
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95005169
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95005169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: