MEDICARE: LEYDIS MARLEN EAWAZ ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9337001	FL
2	363LF0000X	Family Nurse Practitioner	95005358	CA

General Provider Information

NPI Number	:	1225584584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEYDIS MARLEN EAWAZ ARNP

Provider Business Mailing Address
First Line	:	1063 POMEROY AVE
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-4406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2371 OWEN ST
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-3212
Country	:	US
Telephone Number	:	408-708-0204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	05/21/2024

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Directions to “ LEYDIS MARLEN EAWAZ ARNP” Practice Location

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