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NPI Code Detail

MEDICARE: MISS EILEEN MARIE DONNELLY PA

MEDICARE: MISS EILEEN MARIE DONNELLY PA
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
1363AM0700XMedical Physician AssistantPA11304CA

General Provider Information

NPI Number : 1558435297
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS EILEEN MARIE DONNELLY PA
Provider Business Mailing Address
First Line : PO BOX 542
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95061-0542
Country : US
Telephone Number : 831-427-3500
Fax Number :
Provider Business Practice Location Address
First Line : 1510 CAPITOLA RD
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95062-2912
Country : US
Telephone Number : 831-427-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 12/07/2022

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Directions to “ MISS EILEEN MARIE DONNELLY PA” Practice Location

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