Provider Demographics
NPI:1760924849
Name:EVANS, JULIA (PHD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 S COAST DR STE 225
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7757
Mailing Address - Country:US
Mailing Address - Phone:949-743-1457
Mailing Address - Fax:949-274-8299
Practice Address - Street 1:940 S COAST DR STE 225
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7757
Practice Address - Country:US
Practice Address - Phone:949-743-1457
Practice Address - Fax:949-274-8299
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28398103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY28398OtherLICENSE