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NPI Code Detail

MEDICARE: EVAN MACDONALD

MEDICARE: EVAN MACDONALD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1164887451
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN MACDONALD
Provider Business Mailing Address
First Line : 1835 PARK AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95126-1629
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1835 PARK AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95126-1629
Country : US
Telephone Number : 303-989-8169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2015
Last Update Date : 11/14/2019

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Directions to “ EVAN MACDONALD ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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