Provider Demographics
NPI:1417664632
Name:EVANS.AL-SALAHUDDIN, TUNISIA ISMALIA (CPT1 AND RADI)
Entity Type:Individual
Prefix:
First Name:TUNISIA
Middle Name:ISMALIA
Last Name:EVANS.AL-SALAHUDDIN
Suffix:
Gender:F
Credentials:CPT1 AND RADI
Other - Prefix:
Other - First Name:TUNISA
Other - Middle Name:ISMALIA
Other - Last Name:EVANS. AL-SALAHUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT1 AND RADI
Mailing Address - Street 1:1341 DUSTIN DR APT 15
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2724
Mailing Address - Country:US
Mailing Address - Phone:925-325-1367
Mailing Address - Fax:
Practice Address - Street 1:1341 DUSTIN DR #15
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993
Practice Address - Country:US
Practice Address - Phone:925-325-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-02208776202K00000X
CAR1477350822374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology