Healthcare Provider Details

I. General information

NPI: 1770447997
Provider Name (Legal Business Name): WEA CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

250 QUAIL RIDGE RD
SCOTTS VALLEY CA
95066-4821
US

IV. Provider business mailing address

250 QUAIL RIDGE RD
SCOTTS VALLEY CA
95066-4821
US

V. Phone/Fax

Practice location:
  • Phone: 408-341-9606
  • Fax:
Mailing address:
  • Phone: 408-341-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TYLER B EVANS
Title or Position: CEO
Credential:
Phone: 917-648-1068