Provider Demographics
NPI:1356812978
Name:EUGENIO, DONNA LAW (RCP/CRTT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LAW
Last Name:EUGENIO
Suffix:
Gender:F
Credentials:RCP/CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MERCED ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4201
Mailing Address - Country:US
Mailing Address - Phone:510-454-4647
Mailing Address - Fax:510-454-4631
Practice Address - Street 1:2500 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-454-4647
Practice Address - Fax:510-454-4631
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17864207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17864OtherCALIFORNIA BOARD OF RESPIRATORY CARE