Healthcare Provider Details

I. General information

NPI: 1215606942
Provider Name (Legal Business Name): CHRISTINE MARIE EVANS BFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W CYPRESS AVE
MONROVIA CA
91016-4157
US

IV. Provider business mailing address

5319 UNIVERSITY DR UNIT 461
IRVINE CA
92612-2965
US

V. Phone/Fax

Practice location:
  • Phone: 626-618-5653
  • Fax: 877-399-1557
Mailing address:
  • Phone: 831-586-5329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: