Provider Demographics
NPI:1306491865
Name:JAMES-JARVIS, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:JAMES-JARVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 KENWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1001
Mailing Address - Country:US
Mailing Address - Phone:708-769-7841
Mailing Address - Fax:
Practice Address - Street 1:1600 N CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1109
Practice Address - Country:US
Practice Address - Phone:619-956-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator