Healthcare Provider Details

I. General information

NPI: 1063326395
Provider Name (Legal Business Name): EVERTON HEALTH AND WELLNESS PHYSICIAN ASSISTANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 SUTHERLAND LN APT 3
CAPITOLA CA
95010-2423
US

IV. Provider business mailing address

1117 SUTHERLAND LN APT 3
CAPITOLA CA
95010-2423
US

V. Phone/Fax

Practice location:
  • Phone: 408-404-8108
  • Fax:
Mailing address:
  • Phone: 408-404-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CRISTINA CASTELLANOS JIMENEZ
Title or Position: PRESIDENT
Credential: PA-C
Phone: 408-404-8108