Provider Demographics
NPI:1255717104
Name:TISCHOFER, EVAN
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:TISCHOFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1538
Mailing Address - Country:US
Mailing Address - Phone:818-738-7344
Mailing Address - Fax:818-738-7346
Practice Address - Street 1:6801 COLDWATER CANYON AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5162
Practice Address - Country:US
Practice Address - Phone:818-738-7344
Practice Address - Fax:818-738-7346
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator