Provider Demographics
NPI:1720466923
Name:EVOLUTION CONSULTING INC.
Entity Type:Organization
Organization Name:EVOLUTION CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-456-1212
Mailing Address - Street 1:1232 E SERVICE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3857
Mailing Address - Country:US
Mailing Address - Phone:626-456-1212
Mailing Address - Fax:
Practice Address - Street 1:1232 E SERVICE AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3857
Practice Address - Country:US
Practice Address - Phone:626-456-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095023103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942562616OtherBCBA
CA1558480731Medicare PIN
CA1083002604Medicare PIN