MEDICARE: JENNIFER EVANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1053262436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER EVANS

Provider Business Mailing Address
First Line	:	2700 AVIATION BLVD APT 12
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-1900
Country	:	US
Telephone Number	:	424-327-3832
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 AVIATION BLVD APT 12
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-1900
Country	:	US
Telephone Number	:	424-327-3832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	03/11/2026

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Directions to “ JENNIFER EVANS ” Practice Location

Language	Start Address	Practice Location

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