Provider Demographics
NPI:1225584584
Name:EAWAZ, LEYDIS MARLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:LEYDIS
Middle Name:MARLEN
Last Name:EAWAZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LEYDIS
Other - Middle Name:MARLEN
Other - Last Name:VARONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2725 BALL PL UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5601 GREAT OAKS PKWY BLDG 50
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1003
Practice Address - Country:US
Practice Address - Phone:669-255-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9337001363LF0000X, 363LF0000X
CA95005358363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1225584584Medicaid