Provider Demographics
NPI:1083604755
Name:JANKOWSKI, EVELYN DIANNA (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:DIANNA
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6916
Mailing Address - Country:US
Mailing Address - Phone:818-368-5651
Mailing Address - Fax:818-363-4770
Practice Address - Street 1:10316 WOODLEY AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6916
Practice Address - Country:US
Practice Address - Phone:818-368-5651
Practice Address - Fax:818-363-4770
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG032630207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A45222Medicare UPIN
W14505Medicare ID - Type Unspecified