Provider Demographics
NPI:1851756845
Name:EVANS, ALEXANDREA
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:
Last Name:EVANS
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 1:2531 W BROOKHART WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-3724
Mailing Address - Country:US
Mailing Address - Phone:415-827-2051
Mailing Address - Fax:
Practice Address - Street 1:2527 KELLY ST
Practice Address - Street 2:APT. 6
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3348
Practice Address - Country:US
Practice Address - Phone:415-827-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054045650390200000X
AZD11441847390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program