MEDICARE: TERRANCE LEE EVENMO RDCS

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	246X00000X	Cardiovascular Specialist/Technologist	114338	CA

General Provider Information

NPI Number	:	1730035783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE LEE EVENMO RDCS

Provider Business Mailing Address
First Line	:	700 NEW STINE RD APT 25
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-2995
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 NEW STINE RD APT 25
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-2995
Country	:	US
Telephone Number	:	509-951-8920
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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