Healthcare Provider Details

I. General information

NPI: 1649518556
Provider Name (Legal Business Name): EVA MAGDALENA HAWKINS LCSW 21988
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 05/14/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALIFORNIA MENS COLONY HIGHWAY 1, COLONY DRIVE
SAN LUIS OBISPO CA
93409-8101
US

IV. Provider business mailing address

CALIFORNIA MENS COLONY P.O. BOX 8101
SAN LUIS OBISPO CA
93409-8101
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-7900
  • Fax: 805-547-7764
Mailing address:
  • Phone: 805-547-7900
  • Fax: 805-547-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW21988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: