Healthcare Provider Details

I. General information

NPI: 1619806635
Provider Name (Legal Business Name): EVELYN D HUAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN D HUAMAN RDHAP

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 RIALTO GLN
ESCONDIDO CA
92025-7350
US

IV. Provider business mailing address

244 RIALTO GLN
ESCONDIDO CA
92025-7350
US

V. Phone/Fax

Practice location:
  • Phone: 424-202-8691
  • Fax:
Mailing address:
  • Phone: 424-202-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number20371
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP1208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: