Provider Demographics
NPI:1356757215
Name:AVALOS, EVELYN (MS)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 RANCHO DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6443
Mailing Address - Country:US
Mailing Address - Phone:619-519-4481
Mailing Address - Fax:
Practice Address - Street 1:713 BROADWAY STE E
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5313
Practice Address - Country:US
Practice Address - Phone:619-600-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 23245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist