Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1053674838 |
---|---|
Provider Name | Denisha Evans |
First Address | Pasadena, CA 91105-2711 |
Second Address | Pasadena, CA 91105-2711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 17/08/2016 |