Healthcare Provider Details

I. General information

NPI: 1912096553
Provider Name (Legal Business Name): EVELYN HENAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 WEST 6TH STREET
LOS ANGELES CA
90017-1800
US

IV. Provider business mailing address

1600 E HILL STREET
SIGNAL HILL CA
90755-3682
US

V. Phone/Fax

Practice location:
  • Phone: 213-975-9626
  • Fax: 213-895-0637
Mailing address:
  • Phone: 562-424-6200
  • Fax: 562-427-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA44512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: