Provider Demographics
NPI:1114233822
Name:SERVIN, EVELIA R
Entity Type:Individual
Prefix:
First Name:EVELIA
Middle Name:R
Last Name:SERVIN
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 1:22366 FULLER AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-6226
Mailing Address - Country:US
Mailing Address - Phone:510-330-3138
Mailing Address - Fax:
Practice Address - Street 1:22366 FULLER AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-6226
Practice Address - Country:US
Practice Address - Phone:511-300-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker