MEDICARE: DR. ALICEA EVANS

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
1	103T00000X	Psychologist	PSY34598	CA

General Provider Information

NPI Number	:	1720489412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICEA EVANS

Provider Business Mailing Address
First Line	:	14850 HIGHWAY 4 STE A
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2237
Country	:	US
Telephone Number	:	925-257-2985
Fax Number	:

Provider Business Practice Location Address
First Line	:	14850 HIGHWAY 4 STE A
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2237
Country	:	US
Telephone Number	:	925-257-2985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	06/10/2024

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Directions to “ DR. ALICEA EVANS ” Practice Location

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