Provider Demographics
NPI:1356144125
Name:JETTON-RANGEL, EVELYN M
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:M
Last Name:JETTON-RANGEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5641
Mailing Address - Country:US
Mailing Address - Phone:909-568-1258
Mailing Address - Fax:
Practice Address - Street 1:9112 KIRKWOOD AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5641
Practice Address - Country:US
Practice Address - Phone:909-568-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician