Provider Demographics
NPI:1225803398
Name:MUSGROVE, EVIN N
Entity Type:Individual
Prefix:
First Name:EVIN
Middle Name:N
Last Name:MUSGROVE
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 1:11428 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3311
Mailing Address - Country:US
Mailing Address - Phone:574-339-7921
Mailing Address - Fax:
Practice Address - Street 1:11428 IRIS ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3311
Practice Address - Country:US
Practice Address - Phone:574-339-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program