Provider Demographics
NPI:1568063998
Name:EGUIA, JONATHAN (RN-BC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:EGUIA
Suffix:
Gender:M
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 BABSON DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6400
Mailing Address - Country:US
Mailing Address - Phone:619-888-5273
Mailing Address - Fax:
Practice Address - Street 1:10161 CROYDON WAY STE 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2107
Practice Address - Country:US
Practice Address - Phone:619-888-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA836733163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health