Individual
EVAN SIRC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1661 SOQUEL DR STE G, SANTA CRUZ, CA 95065-1709
(831) 476-7711
Mailing address
1661 SOQUEL DR STE G, SANTA CRUZ, CA 95065-1709
(949) 263-8620
(800) 409-7005
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A119825
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A1198250
BCBS OF CA
CA
05
—
1003019654
—
CA
Enumeration date
06/08/2007
Last updated
10/16/2013
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