Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 19553 | CA |
NPI | 1073675179 |
---|---|
Provider Name | Eva Marie Zazueta-Lara |
First Address | Santa Rosa, CA 95404-4428 |
Second Address | Santa Rosa, CA 95404-4428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 26/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073675179 | (05) | CA |