Healthcare Provider Details

I. General information

NPI: 1508459892
Provider Name (Legal Business Name): EVON ANGIE SALMON CMT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 E EVERETT PL
ORANGE CA
92867-6905
US

IV. Provider business mailing address

1143 E EVERETT PL
ORANGE CA
92867-6905
US

V. Phone/Fax

Practice location:
  • Phone: 657-527-7316
  • Fax:
Mailing address:
  • Phone: 657-527-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number48059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: