MEDICARE: DR. DONNA EVELYN PH.D.

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	103TC0700X	Clinical Psychologist	PSY15795	CA

General Provider Information

NPI Number	:	1790819464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA EVELYN PH.D.

Provider Business Mailing Address
First Line	:	31946 MISSION TRL STE B
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4539
Country	:	US
Telephone Number	:	951-245-7663
Fax Number	:	951-674-6431

Provider Business Practice Location Address
First Line	:	31946 MISSION TRL
Second Line	:	STE B
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4539
Country	:	US
Telephone Number	:	951-245-7663
Fax Number	:	951-674-6431

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	02/24/2015

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