Provider Demographics
NPI:1689563074
Name:EUSTAQUIO, ELISA LENON
Entity type:Individual
Prefix:MISS
First Name:ELISA
Middle Name:LENON
Last Name:EUSTAQUIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8262 PEARL DIVER CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7184
Mailing Address - Country:US
Mailing Address - Phone:626-246-8926
Mailing Address - Fax:
Practice Address - Street 1:8262 PEARL DIVER CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7184
Practice Address - Country:US
Practice Address - Phone:626-246-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN61432163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health