Individual
BERT DEWAYNE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
22576 SOUTH RD, APPLE VALLEY, CA 92307-1933
(619) 565-8348
Mailing address
22576 SOUTH RD, APPLE VALLEY, CA 92307-1933
(619) 565-8348
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
170451
CA
Other
Enumeration date
03/20/2009
Last updated
03/20/2009
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