Provider Demographics
NPI:1699744813
Name:WASEF, EVA S (MD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:S
Last Name:WASEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21530
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89721-1530
Mailing Address - Country:US
Mailing Address - Phone:775-844-2455
Mailing Address - Fax:775-884-0345
Practice Address - Street 1:150 PIONEER LANE
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2563
Practice Address - Country:US
Practice Address - Phone:775-884-2455
Practice Address - Fax:775-884-0345
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34605207ZC0500X, 207ZP0102X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A346050OtherDHS PPIN
CAWA34605DMedicare ID - Type UnspecifiedPPIN
CA00A346050OtherDHS PPIN
CAF10215Medicare UPIN