Provider Demographics
NPI:1194021261
Name:EVARO, SELENA MARIE (NA)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:MARIE
Last Name:EVARO
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:MARIE
Other - Last Name:DELAGARZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4634 FRAZIER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3218
Mailing Address - Country:US
Mailing Address - Phone:661-303-7746
Mailing Address - Fax:661-836-1752
Practice Address - Street 1:4634 FRAZIER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3218
Practice Address - Country:US
Practice Address - Phone:661-303-7746
Practice Address - Fax:661-836-1752
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)