Individual
EUNICE IM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
8110 AIRPORT BLVD, LOS ANGELES, CA 90045-3119
(310) 674-0144
(310) 674-1704
Mailing address
8110 AIRPORT BLVD, LOS ANGELES, CA 90045-3119
(310) 674-0144
(310) 674-1704
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
20789
CA
363LG0600X
Gerontology Nurse Practitioner
20789
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20789
CA STATE LICENSE
CA
Enumeration date
10/11/2011
Last updated
03/06/2012
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