Provider Demographics
NPI:1114344637
Name:EVANS, DENNIS ARTHUR JR
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ARTHUR
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 GAVIOTA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1611
Mailing Address - Country:US
Mailing Address - Phone:949-709-4262
Mailing Address - Fax:
Practice Address - Street 1:73 GAVIOTA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-1611
Practice Address - Country:US
Practice Address - Phone:949-709-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator