Healthcare Provider Details

I. General information

NPI: 1134552524
Provider Name (Legal Business Name): EVAN SOLA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 BALBOA ST
SAN FRANCISCO CA
94121-2604
US

IV. Provider business mailing address

286 SANTA CLARA AVE
OAKLAND CA
94610-2604
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-5955
  • Fax: 415-668-0246
Mailing address:
  • Phone: 415-562-6291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: