Healthcare Provider Details

I. General information

NPI: 1447964283
Provider Name (Legal Business Name): EVET YOHANA RADT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W CENTER ST STE 12AND14
MANTECA CA
95337-7300
US

IV. Provider business mailing address

955 W CENTER ST
MANTECA CA
95337-7300
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-9600
  • Fax:
Mailing address:
  • Phone: 209-239-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: