Provider Demographics
NPI:1336922236
Name:SOUISA, EUGENIE
Entity Type:Individual
Prefix:
First Name:EUGENIE
Middle Name:
Last Name:SOUISA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EUGENIE
Other - Middle Name:
Other - Last Name:SOUISA-MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1024 SPARROW CT
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-4923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:935 E CAMPUS WAY
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3121
Practice Address - Country:US
Practice Address - Phone:951-929-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty