Provider Demographics
NPI:1538585708
Name:EVANS, ELIZABETH (CMT, NCTMB)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:CMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 FLYNN AVE APT A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3945
Mailing Address - Country:US
Mailing Address - Phone:650-793-1410
Mailing Address - Fax:
Practice Address - Street 1:20045 STEVENS CREEK BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2356
Practice Address - Country:US
Practice Address - Phone:408-446-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37129175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath