Provider Demographics
NPI:1659610665
Name:LEGASPI, EILEEN R
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:R
Last Name:LEGASPI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:R
Other - Last Name:LEGASPI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 580570
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0010
Mailing Address - Country:US
Mailing Address - Phone:916-512-1006
Mailing Address - Fax:877-781-8669
Practice Address - Street 1:87 SCRIPPS DR STE 210
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6381
Practice Address - Country:US
Practice Address - Phone:916-512-1006
Practice Address - Fax:877-781-8669
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily