=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831919760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EON CARE CLINICIANS OF CA, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2024
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20451 SENECA MEADOWS PKWY
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20876-7005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-515-7260
-----------------------------------------------------
Fax | 202-478-5119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20451 SENECA MEADOWS PKWY
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20876-7005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-515-7260
-----------------------------------------------------
Fax | 202-478-5119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | KELLY JOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 667-218-3396
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------