Healthcare Provider Details

I. General information

NPI: 1740927466
Provider Name (Legal Business Name): MARI EVANS MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 05/14/2022
Certification Date: 05/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3915 PARK VISTA PL
GLENDALE CA
91214-3373
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2110
  • Fax:
Mailing address:
  • Phone: 734-882-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: