Healthcare Provider Details

I. General information

NPI: 1417664632
Provider Name (Legal Business Name): TUNISIA ISMALIA EVANS.AL-SALAHUDDIN DOCTORAL, MS, CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TUNISA ISMALIA EVANS. AL-SALAHUDDIN CPT1 AND RADI

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 DUSTIN DR #15
YUBA CITY CA
95993
US

IV. Provider business mailing address

1341 DUSTIN DR APT 15
YUBA CITY CA
95993-2724
US

V. Phone/Fax

Practice location:
  • Phone: 925-325-1367
  • Fax:
Mailing address:
  • Phone: 925-325-1367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberINPROCESS
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberBS-HUMANSERVICES-UOP
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBS-HUMANSERVICES-UOP
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCDC-TRAIN-1895079
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberWALDENDOCOTORALPROGR
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberCDC-TRAIN-1895079
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberALISON-INPROCESS
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberACE-CEU0002837
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberMS-COLORADOSTATEUNIV
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberDOCTOR-EQUIV-180CEU
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCDC-TRAIN-1895079
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberR1477350822
License Number StateCA
# 13
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberMS-COLORADOSTATEUNI
License Number StateCO
# 14
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 15
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberWALDENDOCOTORALPROGR
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: