1427518794 NPI number — EVALONE PRO, LLC

Table of content: ANTOINETTE MARIE AGUILAR (NPI 1548438278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427518794 NPI number — EVALONE PRO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVALONE PRO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427518794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1749 POTRERO GRANDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91755-5851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-471-1290
Provider Business Mailing Address Fax Number:
626-270-4409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 E DEVONSHIRE AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92543-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-471-1326
Provider Business Practice Location Address Fax Number:
626-270-4409
Provider Enumeration Date:
03/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMARAL
Authorized Official First Name:
SALVADOR
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPS.
Authorized Official Telephone Number:
626-471-1290

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)