Provider Demographics
NPI:1295301364
Name:DEAN, EVANGELINE (CMT)
Entity type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:EVIE
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2450 HERNDON AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8960
Mailing Address - Country:US
Mailing Address - Phone:559-904-3598
Mailing Address - Fax:
Practice Address - Street 1:2450 HERNDON AVE APT 203
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8960
Practice Address - Country:US
Practice Address - Phone:559-904-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82037225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist