Provider Demographics
NPI:1932940418
Name:FREGOSO, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:FREGOSO
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 1:661 ROBERTS LN STE B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-4723
Mailing Address - Country:US
Mailing Address - Phone:661-393-5839
Mailing Address - Fax:661-393-4075
Practice Address - Street 1:661 ROBERTS LN STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4723
Practice Address - Country:US
Practice Address - Phone:661-393-5839
Practice Address - Fax:661-393-4075
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker