Healthcare Provider Details

I. General information

NPI: 1679011589
Provider Name (Legal Business Name): EILEEN DE LOS REYES NATH RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2017
Last Update Date: 02/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LA CASA VIA STE 205
WALNUT CREEK CA
94598-3017
US

IV. Provider business mailing address

945 OAK VIEW CIR
LAFAYETTE CA
94549-4615
US

V. Phone/Fax

Practice location:
  • Phone: 925-464-3916
  • Fax:
Mailing address:
  • Phone: 562-310-5665
  • Fax: 925-954-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: