Provider Demographics
NPI:1487087599
Name:CHANGCOCO, EUSEBIA BALLESTERO (RN)
Entity type:Individual
Prefix:MRS
First Name:EUSEBIA
Middle Name:BALLESTERO
Last Name:CHANGCOCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12237 HILLSDALE AVE
Mailing Address - Street 2:VILLAGE GREEN
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-5136
Mailing Address - Country:US
Mailing Address - Phone:818-833-8028
Mailing Address - Fax:
Practice Address - Street 1:12237 HILLSDALE AVE
Practice Address - Street 2:VILLAGE GREEN
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-5136
Practice Address - Country:US
Practice Address - Phone:818-833-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724372163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult