Healthcare Provider Details

I. General information

NPI: 1730095860
Provider Name (Legal Business Name): EVELYN MARIE BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 AIRWAY AVE STE A
COSTA MESA CA
92626-4650
US

IV. Provider business mailing address

4490 VIA AMABLE
SAN DIEGO CA
92122-1591
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-0427
  • Fax:
Mailing address:
  • Phone: 408-601-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: