Healthcare Provider Details

I. General information

NPI: 1205955291
Provider Name (Legal Business Name): EVELYN E VIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 ARNOLD DR STE 102
MARTINEZ CA
94553-4190
US

IV. Provider business mailing address

3485 CHANDLER CIR
BAY POINT CA
94565-6917
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-9562
  • Fax: 925-228-2932
Mailing address:
  • Phone: 925-787-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: