Provider Demographics
NPI:1427212679
Name:EVANS, MARIA ELENA (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ELENA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 ALHAMBRA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-4611
Mailing Address - Country:US
Mailing Address - Phone:361-742-5992
Mailing Address - Fax:361-937-2546
Practice Address - Street 1:6500 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 38
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4065
Practice Address - Country:US
Practice Address - Phone:361-742-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT036163225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist