Provider Demographics
NPI:1134259237
Name:NANCY EUGENIO MD INC
Entity type:Organization
Organization Name:NANCY EUGENIO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:EUGENIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-5939
Mailing Address - Street 1:2690 PACIFIC AVE
Mailing Address - Street 2:#340
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:526-595-5939
Mailing Address - Fax:526-595-9316
Practice Address - Street 1:2690 PACIFIC AVE
Practice Address - Street 2:#340
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:526-595-5939
Practice Address - Fax:526-595-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45377207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45377Medicare ID - Type Unspecified
CA00G453770Medicare ID - Type Unspecified
A50006Medicare UPIN