MEDICARE: EVA COOC

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	163W00000X	Registered Nurse	825880	CA

General Provider Information

NPI Number	:	1679346399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA COOC

Provider Business Mailing Address
First Line	:	4017 STEVENS ST
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4447
Country	:	US
Telephone Number	:	510-318-0503
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 STEVENS ST
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4447
Country	:	US
Telephone Number	:	510-318-0503
Fax Number	:

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

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	11/05/2023

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Directions to “ EVA COOC ” Practice Location

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