MEDICARE: EVELYN LARIOS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720535891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN LARIOS

Provider Business Mailing Address
First Line	:	4400 W WASHINGTON BLVD
Second Line	:	APT # 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1754
Country	:	US
Telephone Number	:	323-240-4958
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 W WASHINGTON BLVD
Second Line	:	APT #202
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1754
Country	:	US
Telephone Number	:	323-240-4958
Fax Number	:

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

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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Directions to “ EVELYN LARIOS ” Practice Location

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