Provider Demographics
NPI:1851014765
Name:DIABUAH, EUNICE EZINNE
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:EZINNE
Last Name:DIABUAH
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 1:405 W WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3304
Mailing Address - Country:US
Mailing Address - Phone:909-644-7402
Mailing Address - Fax:
Practice Address - Street 1:405 W WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3304
Practice Address - Country:US
Practice Address - Phone:909-644-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698697164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse