=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730035783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRANCE LEE EVENMO RDCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2026
-----------------------------------------------------
Last Update Date | 03/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 NEW STINE RD APT 25
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-2995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-951-8920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 NEW STINE RD APT 25
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-2995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246X00000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Specialist/Technologist
-----------------------------------------------------
License Number | 114338
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------