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NPI Code Detail

MEDICARE: LEANETTE ISOPHINE EVANS

MEDICARE: LEANETTE ISOPHINE 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
1101YA0400XAddiction (Substance Use Disorder) Counselor22421CA

General Provider Information

NPI Number : 1841141371
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANETTE ISOPHINE EVANS
Provider Business Mailing Address
First Line : 721 E HAMMER LN APT 185
Second Line :
City : STOCKTON
State : CA
Zip : 95210-2749
Country : US
Telephone Number : 209-683-9300
Fax Number :
Provider Business Practice Location Address
First Line : 333 N SAN JOAQUIN ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-2954
Country : US
Telephone Number : 209-683-9300
Fax Number : 209-683-9300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ LEANETTE ISOPHINE EVANS ” Practice Location

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