Provider Demographics
NPI:1154378487
Name:EURASQUIN, WANDA E
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:E
Last Name:EURASQUIN
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 1:960 E GREEN ST STE L-80
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2442
Mailing Address - Country:US
Mailing Address - Phone:951-582-4609
Mailing Address - Fax:951-582-4609
Practice Address - Street 1:960 E GREEN ST STE L-80
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2442
Practice Address - Country:US
Practice Address - Phone:951-582-4609
Practice Address - Fax:951-393-1753
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA5066237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0050660Medicaid