MEDICARE: EVAN ENDRES

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	1041C0700X	Clinical Social Worker	108345	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1902274830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN ENDRES

Provider Business Mailing Address
First Line	:	2181 S EL CAMINO REAL STE 204
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6288
Country	:	US
Telephone Number	:	619-549-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	2181 S EL CAMINO REAL STE 204
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6288
Country	:	US
Telephone Number	:	619-549-0329
Fax Number	:

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

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	06/08/2022

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Directions to “ EVAN ENDRES ” Practice Location

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