Provider Demographics
NPI:1073675179
Name:ZAZUETA-LARA, EVA MARIE (PHN, WHNP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:ZAZUETA-LARA
Suffix:
Gender:F
Credentials:PHN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9490
Mailing Address - Country:US
Mailing Address - Phone:707-657-9528
Mailing Address - Fax:
Practice Address - Street 1:9828 BERRY LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9490
Practice Address - Country:US
Practice Address - Phone:707-657-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587221163WC1500X
CA19553363LW0102X
CALM478176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073675179Medicaid