Provider Demographics
NPI:1942334073
Name:GAVIOLA, EVELYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:GAVIOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:ELTANAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2670 S WHITE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2072
Mailing Address - Country:US
Mailing Address - Phone:408-606-2333
Mailing Address - Fax:888-977-3501
Practice Address - Street 1:2670 S WHITE RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148
Practice Address - Country:US
Practice Address - Phone:408-606-2333
Practice Address - Fax:888-977-3501
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2E512Medicare PIN