Healthcare Provider Details

I. General information

NPI: 1295375038
Provider Name (Legal Business Name): EVELYN CRYSTAL SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E DEL MAR BLVD
PASADENA CA
91101-2714
US

IV. Provider business mailing address

301 E DEL MAR BLVD
PASADENA CA
91101-2714
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-2016
  • Fax:
Mailing address:
  • Phone: 626-796-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: