Provider Demographics
NPI:1083362214
Name:KING, EVA ELIZABETH (MS, ATC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:ELIZABETH
Last Name:KING
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4213 KANSAS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1846
Mailing Address - Country:US
Mailing Address - Phone:707-364-9766
Mailing Address - Fax:
Practice Address - Street 1:4490 W POINT LOMA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1006
Practice Address - Country:US
Practice Address - Phone:978-766-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2024-02-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer