Healthcare Provider Details

I. General information

NPI: 1285598342
Provider Name (Legal Business Name): MR. CARTER C EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MURRAY CIR
SAUSALITO CA
94965
US

IV. Provider business mailing address

599 TOMALES RD
PETALUMA CA
94952-5002
US

V. Phone/Fax

Practice location:
  • Phone: 415-331-8247
  • Fax:
Mailing address:
  • Phone: 707-765-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: