Provider Demographics
NPI:1679015762
Name:EVANS, CHRISTIAN (MAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:GIAMANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT, ATC
Mailing Address - Street 1:5331 MOUNT ALIFAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2622
Mailing Address - Country:US
Mailing Address - Phone:858-244-0333
Mailing Address - Fax:
Practice Address - Street 1:5331 MOUNT ALIFAN DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2622
Practice Address - Country:US
Practice Address - Phone:858-244-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000020122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer