Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 44407 | CA |
NPI | 1063453603 |
---|---|
Provider Name | Dr. Evan Stuart Halpern |
First Address | Etiwanda, CA 91739-8916 |
Second Address | Rialto, CA 92376-8062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |