Provider Demographics
NPI:1881434876
Name:EVANS, CORAL A
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:A
Last Name:EVANS
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 1:2733 BREWER ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8859
Mailing Address - Country:US
Mailing Address - Phone:209-650-5030
Mailing Address - Fax:
Practice Address - Street 1:2733 BREWER ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8859
Practice Address - Country:US
Practice Address - Phone:209-650-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician