Healthcare Provider Details

I. General information

NPI: 1831637958
Provider Name (Legal Business Name): EVAN SHAWLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # 8770
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

200 W ARBOR DR # 8770
SAN DIEGO CA
92103-1911
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA181079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: