Provider Demographics
NPI:1730580267
Name:EVANS, NATHAN (HIS)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 PORTAGE ROCK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 S COAST DR
Practice Address - Street 2:SUITE 243
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1776
Practice Address - Country:US
Practice Address - Phone:714-754-1889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIHT1447237700000X
CAHT9123237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist