Healthcare Provider Details

I. General information

NPI: 1548867690
Provider Name (Legal Business Name): ELOISA OQUENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELOISA OQUENDO

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 BERKLEY RD
GIBBSTOWN NJ
08027-1608
US

IV. Provider business mailing address

1118 BERKLEY RD
GIBBSTOWN NJ
08027-1608
US

V. Phone/Fax

Practice location:
  • Phone: 856-366-8869
  • Fax:
Mailing address:
  • Phone: 856-366-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0450545807
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: