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NPI Code Detail

MEDICARE: EIRENA ELIZABETH EWERT

MEDICARE: EIRENA ELIZABETH EWERT
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1437790904
Entity Type Code : Individual
Provider Name (Legal Business Name) : EIRENA ELIZABETH EWERT
Provider Business Mailing Address
First Line : 250 CHERRY LN STE 109
Second Line :
City : MANTECA
State : CA
Zip : 95337-4397
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8885 RIO SAN DIEGO DR STE 340
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1669
Country : US
Telephone Number : 619-795-9925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2019
Last Update Date : 06/15/2026

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Directions to “ EIRENA ELIZABETH EWERT ” Practice Location

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