Provider Demographics
NPI:1508459892
Name:SALMON, EVON ANGIE (CMT LMT)
Entity Type:Individual
Prefix:
First Name:EVON
Middle Name:ANGIE
Last Name:SALMON
Suffix:
Gender:F
Credentials:CMT LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 MURLINE DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-1242
Mailing Address - Country:US
Mailing Address - Phone:714-605-8942
Mailing Address - Fax:
Practice Address - Street 1:9401 MURLINE DR
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1242
Practice Address - Country:US
Practice Address - Phone:714-605-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist