Provider Demographics
NPI:1467804930
Name:FRANCO, EGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:EGINIA
Middle Name:
Last Name:FRANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12746 W JEFFERSON BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2885
Mailing Address - Country:US
Mailing Address - Phone:424-315-2220
Mailing Address - Fax:
Practice Address - Street 1:12746 W JEFFERSON BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2776
Practice Address - Country:US
Practice Address - Phone:424-315-2220
Practice Address - Fax:424-315-2221
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211982207Q00000X
CAA169409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine