Healthcare Provider Details

I. General information

NPI: 1073675179
Provider Name (Legal Business Name): EVA MARIE ZAZUETA-LARA PHN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9828 BERRY LN
WINDSOR CA
95492-9490
US

IV. Provider business mailing address

9828 BERRY LN
WINDSOR CA
95492-9490
US

V. Phone/Fax

Practice location:
  • Phone: 707-657-9528
  • Fax:
Mailing address:
  • Phone: 707-657-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number587221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number19553
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: