Provider Demographics
NPI:1295206829
Name:EVANS, AMBER MARIE (RDN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 SANTA QUETA
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1527
Mailing Address - Country:US
Mailing Address - Phone:858-775-9471
Mailing Address - Fax:
Practice Address - Street 1:932 SANTA QUETA
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1527
Practice Address - Country:US
Practice Address - Phone:858-775-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered