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General NPI Number Information
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NPI Number | 1760607410
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Entity Type | Organization
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Legal Business Name | L.EVANS MD, INC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 418 N FAIR OAKS AVE SUITE 201
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City | PASADENA
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State | CA
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Zip | 91103-3659
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Country | US
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Telephone | 626-605-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 466 FOOTHILL BLVD #115
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City | LA CANADA
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State | CA
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Zip | 91011-3518
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Country | US
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Telephone | 626-354-7316
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Fax | 626-744-1522
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURA ELLEN EVANS
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Credential | M.D.
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Telephone | 626-354-7316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A77877
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License Number State | CA
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