MEDICARE: EVELYN LOUISE EVANS PA-C, MS

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	363A00000X	Physician Assistant	59980	CA
2	363A00000X	Physician Assistant	61034531	WA

General Provider Information

NPI Number	:	1801416839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN LOUISE EVANS PA-C, MS

Provider Business Mailing Address
First Line	:	9850 GENESEE AVE STE 320
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1208
Country	:	US
Telephone Number	:	858-554-1212
Fax Number	:	858-795-1195

Provider Business Practice Location Address
First Line	:	1905 CALLE BARCELONA STE 211
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-8452
Country	:	US
Telephone Number	:	858-554-1212
Fax Number	:	858-795-1195

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

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	03/23/2026

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