Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A100346 | CA |
NPI | 1003015124 |
---|---|
Provider Name | Jessica A Evert |
First Address | Walnut Creek, CA 94598-0917 |
Second Address | Walnut Creek, CA 94598-2990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 13/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A00100346 | (05) | CA |