Provider Demographics
NPI:1881298305
Name:MADRUENO, EVA MARIA
Entity type:Individual
Prefix:MRS
First Name:EVA
Middle Name:MARIA
Last Name:MADRUENO
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 1:1815 W 152ND ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-2735
Mailing Address - Country:US
Mailing Address - Phone:562-884-4624
Mailing Address - Fax:
Practice Address - Street 1:1815 W 152ND ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-2735
Practice Address - Country:US
Practice Address - Phone:562-884-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily