Healthcare Provider Details

I. General information

NPI: 1619598745
Provider Name (Legal Business Name): ANDREA EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 KIRKWOOD AVE
SAN FRANCISCO CA
94124-2137
US

IV. Provider business mailing address

1638 KIRKWOOD AVE
SAN FRANCISCO CA
94124-2137
US

V. Phone/Fax

Practice location:
  • Phone: 415-539-8302
  • Fax:
Mailing address:
  • Phone: 415-814-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: