Provider Demographics
NPI:1932745049
Name:EWART, ANA KRISTEL
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:KRISTEL
Last Name:EWART
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 1:26081 MOCINE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-2923
Mailing Address - Country:US
Mailing Address - Phone:510-963-9707
Mailing Address - Fax:
Practice Address - Street 1:26081 MOCINE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2923
Practice Address - Country:US
Practice Address - Phone:510-963-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2298089163W00000X
CA950155082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No163W00000XNursing Service ProvidersRegistered Nurse