Provider Demographics
NPI:1497457238
Name:EVANSON, SABRINA CAROL
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:CAROL
Last Name:EVANSON
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 1:5232 MICHELSON DR APT 20D
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2901
Mailing Address - Country:US
Mailing Address - Phone:916-759-3456
Mailing Address - Fax:
Practice Address - Street 1:140 E COMMONWEALTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1905
Practice Address - Country:US
Practice Address - Phone:714-572-3900
Practice Address - Fax:714-572-4300
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62358208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice