Healthcare Provider Details

I. General information

NPI: 1720758980
Provider Name (Legal Business Name): EVELYN NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27403 YNEZ RD STE 108
TEMECULA CA
92591-4619
US

IV. Provider business mailing address

27403 YNEZ RD STE 108
TEMECULA CA
92591-4619
US

V. Phone/Fax

Practice location:
  • Phone: 951-750-7888
  • Fax:
Mailing address:
  • Phone: 951-750-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08240207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95241729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: