MARIO EDUARDO EYZAGUIRRE (NPI# 1205866258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205866258 |
| Entity Type | Individual |
| Full Name | MARIO EDUARDO EYZAGUIRRE |
| Credential | M.D. |
| Practice Address |
4077 5th Ave San Diego CA 92103-2105 |
| Mailing Address |
5626 Sandburg Ave San Diego CA 92122-4132 |
| Practice Telephone | 6192607046 |
| Practice Fax Number | 6196863843 |
| Mailing Telephone | 6192607046 |
| Mailing Fax Number | 6196863843 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
A42572 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
4077 5TH AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92103-2105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932100062 | Julian George Lis | Emergency Medicine | 4077 5th Ave, San Diego, CA 92103-2105 | 2005-08-10 |
| 1154921195 | Michelle Miller | Social Worker | 4077 5th Ave, San Diego, CA 92103-2105 | 2020-10-29 |
| 1356972798 | Andrew Nasseri Md Inc. | Surgery | 4077 5th Ave, San Diego, CA 92103-2105 | 2020-02-03 |
| 1134769573 | Emi Harris | Nurse Practitioner | 4077 5th Ave, San Diego, CA 92103-2105 | 2020-01-14 |
| 1669012217 | Justin Jerluen Lin | Pharmacist | 4077 5th Ave, Mer 52, San Diego, CA 92103 | 2020-01-12 |
| 1972070662 | Blair Shealy | Internal Medicine | 4077 5th Ave, San Diego, CA 92103-2105 | 2018-10-31 |
| 1487143749 | Jovian W Lam | Internal Medicine | 4077 5th Ave, San Diego, CA 92103 | 2018-05-02 |
| 1316452303 | Meghan Murphy | Social Worker | 4077 5th Ave, San Diego, CA 92103-2105 | 2017-12-12 |
| 1508390394 | Kristina Strong | Nurse Practitioner | 4077 5th Ave, San Diego, CA 92103-2105 | 2017-04-18 |
| 1124578117 | Jennifer Agueda | Nurse Practitioner | 4077 5th Ave, San Diego, CA 92103-2105 | 2016-10-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174140057 | Carmel Agdeppa | Acupuncturist | Chiropractique, 813 West Washington St., San Diego, CA 92103 | 2020-06-26 |
| 1568082717 | Salina Ann Bambic | Social Worker | 302 Washington Street Suite 420, San Diego, CA 92103 | 2020-04-17 |
| 1467099432 | Lina Hong | Behavior Technician | 3731 6th Ave. Suite 100, San Diego, Ca 92103, San Diego, CA 92103 | 2019-12-09 |
| 1154964567 | Rodger Stacy Questin, Psychologist P.C. | Psychologist | 440 Upas St Apt 402, San Diego, CA 92103 | 2019-10-18 |
| 1932740388 | Grace Tong-ventura | Pharmacist | 200 W. Arbor Drive, #8765, Suite 1-317, San Diego, CA 92103 | 2019-10-07 |
| 1306490453 | Genevieve Cheung | Pharmacist | 200 W Arbor Dr #8765, Department of Pharmacy, San Diego, CA 92103 | 2019-07-26 |
| 1801356837 | Marika Doviak | Acupuncturist | 2370 Hickory St, San Diego, CA 92103 | 2019-03-25 |
| 1982185070 | Tyler Lewis Roberts | Counselor | 4303 3rd Ave, San Diego, CA 92103 | 2018-08-27 |
| 1689151284 | Tori Breanne Blackwell | Occupational Therapist | 3731-a 6th Avenue, San Diego, CA 92103 | 2018-07-26 |
| 1952892614 | Pacific Bay Recovery Inc | Substance Abuse Rehabilitation Facility | 4095 Jackdaw St, San Diego, CA 92103 | 2018-05-29 |
| Find all providers in zip 92103 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205049038 | Seth Michael Asser | Pediatrics | 3020 Childrens Way # Mc5064, San Diego, CA 92123-4223 | 2007-05-08 |
| 1952726242 | Bradley M. Peterson, M.d., Inc. | Pediatrics | 3030 Childrens Way, #115, San Diego, CA 92123-4232 | 2014-02-24 |
| 1912139320 | Justin Hamrick | Pediatrics | 3626 Ruffin Rd, San Diego, CA 92123 | 2009-08-18 |
| 1649451493 | Clinica Medica Pediatrica Inc | Pediatrics | 3802 National Ave, San Diego, CA 92113-3223 | 2007-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417368804 | Sara Aghamohammadi | Pediatrics | 4650 W Sunset Blvd # Ms 3, Los Angeles, CA 90027-6062 | 2014-05-19 |
| 1023367422 | Batool Alsheikh | Pediatrics | 6235 N Fresno St Ste 103, Fresno, CA 93710 | 2012-08-31 |
| 1699093880 | Richard P Lion | Pediatrics | 11234 Anderson St Rm 5763, Loma Linda, CA 92354-2804 | 2010-05-12 |
| 1558505719 | Ryan Richard Taylor | Pediatrics | Mattel Childrens Hospital At Ucla, 10833 Le Conte Ave., 12-494, Mdcc, Los Angeles, CA 90095-0001 | 2009-04-30 |
| 1871737270 | Shan Lyn Ward | Pediatrics | 3333 California St # S110, San Francisco, CA 94118-1981 | 2009-04-29 |
| 1932341641 | Anas Al Kawass | Pediatrics | 17100 Euclid Street, Picu, Fountain Valley, CA 92708 | 2009-03-26 |
| 1497996649 | Andreas Schwingshackl | Pediatrics | Rrmc 400 Westwood Blvd, Los Angeles, CA 90095-2113 | 2009-03-18 |
| 1588804801 | Carol Elizabeth Nicholson | Pediatrics | 6461 Zuma View Pl, #149, Malibu, CA 90265-4495 | 2009-02-26 |
| 1831355320 | Niveditha Vilasagar | Pediatrics | 4867 W Sunset Blvd Fl 5, Los Angeles, CA 90027-5969 | 2008-08-04 |
| 1154519072 | Eloa S. Adams | Pediatrics | 275 W Macarthu, Oakland, CA 94611-5641 | 2007-10-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.