Healthcare Provider Details

I. General information

NPI: 1407581689
Provider Name (Legal Business Name): EVELYN A ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 E WASHINGTON BLVD
PASADENA CA
91104-2650
US

IV. Provider business mailing address

1421 E WASHINGTON BLVD
PASADENA CA
91104-2650
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-0245
  • Fax:
Mailing address:
  • Phone: 626-296-0245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number84014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: