Provider Demographics
NPI:1417664632
Name:EVANS.AL-SALAHUDDIN, TUNISIA ISMALIA (DOCTORAL, MS, CHW)
Entity type:Individual
Prefix:DR
First Name:TUNISIA
Middle Name:ISMALIA
Last Name:EVANS.AL-SALAHUDDIN
Suffix:
Gender:F
Credentials:DOCTORAL, MS, CHW
Other - Prefix:DR
Other - First Name:TUNISA
Other - Middle Name:ISMALIA
Other - Last Name:EVANS. AL-SALAHUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT1 AND RADI
Mailing Address - Street 1:1341 DUSTIN DR APT 15
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2724
Mailing Address - Country:US
Mailing Address - Phone:925-325-1367
Mailing Address - Fax:
Practice Address - Street 1:1341 DUSTIN DR #15
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993
Practice Address - Country:US
Practice Address - Phone:925-325-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINPROCESS103T00000X
CABS-HUMANSERVICES-UOP171M00000X, 101Y00000X
CACDC-TRAIN-1895079172V00000X, 174H00000X, 251S00000X
MNWALDENDOCOTORALPROGR1744R1102X
CAALISON-INPROCESS2084P0800X
CAACE-CEU0002837225700000X
CAMS-COLORADOSTATEUNIV247000000X
CADOCTOR-EQUIV-180CEU251K00000X
CAR1477350822374700000X
COMS-COLORADOSTATEUNI376G00000X
390200000X
CAWALDENDOCOTORALPROGR251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health Worker
No1744R1102XOther Service ProvidersSpecialistResearch Study
No174H00000XOther Service ProvidersHealth Educator
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No251S00000XAgenciesCommunity/Behavioral Health
No374700000XNursing Service Related ProvidersTechnician
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty