Healthcare Provider Details

I. General information

NPI: 1841656766
Provider Name (Legal Business Name): TANYA Y. EVANS, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27020 ALICIA PKWY STE G
LAGUNA NIGUEL CA
92677-3420
US

IV. Provider business mailing address

27020 ALICIA PKWY STE G
LAGUNA NIGUEL CA
92677-3420
US

V. Phone/Fax

Practice location:
  • Phone: 949-707-5734
  • Fax: 959-707-1924
Mailing address:
  • Phone: 949-707-5734
  • Fax: 959-707-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA68285
License Number StateCA

VIII. Authorized Official

Name: DR. TANYA Y EVANS
Title or Position: OWNER
Credential: M.D.
Phone: 949-707-5734