Provider Demographics
NPI:1083026009
Name:HOWARD, EBEN (PHD, FNP-BC PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:EBEN
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PHD, FNP-BC PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W AVENIDA VISTA HERMOSA STE 122
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-7707
Mailing Address - Country:US
Mailing Address - Phone:949-212-2699
Mailing Address - Fax:888-999-8503
Practice Address - Street 1:101 W AVENIDA VISTA HERMOSA STE 122
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-7707
Practice Address - Country:US
Practice Address - Phone:949-212-2699
Practice Address - Fax:888-999-8503
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493676163W00000X
AR84904163W00000X
CA95001143363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily