1326863564 NPI number — MS. ELEANOR LUZANO NGUYEN PHN, RN

Table of content: BERTHA M VALDEZ LCDC (NPI 1326304585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326863564 NPI number — MS. ELEANOR LUZANO NGUYEN PHN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
ELEANOR
Provider Middle Name:
LUZANO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
LYNN
Provider Other Middle Name:
LUZANO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326863564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 JACKSON ST FL 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94607-4813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-265-8208
Provider Business Mailing Address Fax Number:
510-780-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6694 PALOVERDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTRO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94552-9651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-265-8208
Provider Business Practice Location Address Fax Number:
510-780-8810
Provider Enumeration Date:
11/21/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  9503577 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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