Provider Demographics
NPI:1891896775
Name:EVANS, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29798 HAUN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6541
Mailing Address - Country:US
Mailing Address - Phone:951-672-3332
Mailing Address - Fax:951-672-3352
Practice Address - Street 1:29798 HAUN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-6541
Practice Address - Country:US
Practice Address - Phone:951-672-3332
Practice Address - Fax:951-672-3352
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG058719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG058719OtherLICENSE NUMBER
CAZZZ03555ZOtherGROUP'S PTAN
CA00G587190OtherB/S OF CAL.-INDIVIDUAL #
CAG058719OtherLICENSE NUMBER
CA20-2708669OtherTAX ID NUMBER
CAG058719OtherLICENSE NUMBER