Healthcare Provider Details

I. General information

NPI: 1952546053
Provider Name (Legal Business Name): MICHELE A EVANS MD, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVE OPD 3P61
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2010 ZONAL AVE OPD 3P61
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-5077
  • Fax:
Mailing address:
  • Phone: 323-226-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA101579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: