Provider Demographics
NPI:1851136451
Name:SILVA, EVELYN ROSE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ROSE
Last Name:SILVA
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 1:3791 REDWOOD AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3564
Mailing Address - Country:US
Mailing Address - Phone:951-380-1061
Mailing Address - Fax:
Practice Address - Street 1:3791 REDWOOD AVE APT 13
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3564
Practice Address - Country:US
Practice Address - Phone:951-380-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician