Provider Demographics
NPI:1457586661
Name:PEAIRS, EVELYN INSERRA
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:INSERRA
Last Name:PEAIRS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3901
Mailing Address - Country:US
Mailing Address - Phone:408-486-6818
Mailing Address - Fax:408-248-2271
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE A-101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-486-6818
Practice Address - Fax:408-248-2271
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist