Provider Demographics
NPI:1629825096
Name:BLOOD, EVELYN (RADT)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BLOOD
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 CONRAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-1806
Mailing Address - Country:US
Mailing Address - Phone:619-715-6997
Mailing Address - Fax:
Practice Address - Street 1:1865 HOTEL CIR S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3319
Practice Address - Country:US
Practice Address - Phone:619-673-8166
Practice Address - Fax:619-573-9333
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-RCJFUN175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist