Healthcare Provider Details

I. General information

NPI: 1336801430
Provider Name (Legal Business Name): MS. EVELYN MASCARENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 12/29/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HOPYARD RD STE 140
PLEASANTON CA
94588-8530
US

IV. Provider business mailing address

3825 HOPYARD RD
PLEASANTON CA
94588-8528
US

V. Phone/Fax

Practice location:
  • Phone: 925-847-5051
  • Fax:
Mailing address:
  • Phone: 925-847-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: