MEDICARE: MR. JONATHAN EGUIA RN-BC

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	836733	CA

General Provider Information

NPI Number	:	1568063998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN EGUIA RN-BC

Provider Business Mailing Address
First Line	:	4015 BABSON DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-6400
Country	:	US
Telephone Number	:	619-888-5273
Fax Number	:

Provider Business Practice Location Address
First Line	:	10161 CROYDON WAY STE 2
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2107
Country	:	US
Telephone Number	:	619-888-5273
Fax Number	:

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

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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