Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95017830 | CA |
NPI | 1013453612 |
---|---|
Provider Name | Kelly Eguchi |
First Address | Irvine, CA 92614-6041 |
Second Address | Irvine, CA 92614-6041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2017 |
Last Update Date | 22/11/2021 |