Individual
KELLY EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13947 CASTILLE ST, VICTORVILLE, CA 92392-5508
(760) 261-4242
(760) 261-4338
Mailing address
13947 CASTILLE ST, VICTORVILLE, CA 92392-5508
(760) 261-4242
(760) 261-4338
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
366426751
CA
Other
Enumeration date
12/19/2015
Last updated
07/17/2020
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