Provider Demographics
NPI:1013402445
Name:CARRERA, EDUARDO (LVN)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:CARRERA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:EDUARDO
Other - Middle Name:C
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11210 CORTE PLAYA CORONA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-4134
Mailing Address - Country:US
Mailing Address - Phone:858-495-1713
Mailing Address - Fax:
Practice Address - Street 1:11210 CORTE PLAYA CORONA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-4134
Practice Address - Country:US
Practice Address - Phone:858-495-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206180164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse