Individual
MRS. EVELYN DIVINAGRACIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
3002 DOW AVE, 114, TUSTIN, CA 92780-7233
(714) 731-4668
Mailing address
1262 MAGNOLIA DR, CARSON, CA 90746-7405
(310) 971-5754
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
18689
CA
Other
Enumeration date
03/29/2017
Last updated
03/29/2017
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