=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417664632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TUNISIA ISMALIA EVANS.AL-SALAHUDDIN DOCTORAL, MS, CHW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2022
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1341 DUSTIN DR #15
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-325-1367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1341 DUSTIN DR APT 15
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95993-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-325-1367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | INPROCESS
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | BS-HUMANSERVICES-UOP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | BS-HUMANSERVICES-UOP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number | CDC-TRAIN-1895079
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 1744R1102X
-----------------------------------------------------
Taxonomy Name | Research Study Specialist
-----------------------------------------------------
License Number | WALDENDOCOTORALPROGR
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number | CDC-TRAIN-1895079
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ALISON-INPROCESS
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | ACE-CEU0002837
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 247000000X
-----------------------------------------------------
Taxonomy Name | Health Information Technician
-----------------------------------------------------
License Number | MS-COLORADOSTATEUNIV
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | DOCTOR-EQUIV-180CEU
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | CDC-TRAIN-1895079
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 374700000X
-----------------------------------------------------
Taxonomy Name | Technician
-----------------------------------------------------
License Number | R1477350822
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #13
-----------------------------------------------------
Taxonomy Code | 376G00000X
-----------------------------------------------------
Taxonomy Name | Nursing Home Administrator
-----------------------------------------------------
License Number | MS-COLORADOSTATEUNI
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #14
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #15
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | WALDENDOCOTORALPROGR
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------