Individual
ROSANNE INEZ EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11646 ENCANTO LN, COLTON, CA 92324-9218
(909) 222-4073
Mailing address
11646 ENCANTO LN, COLTON, CA 92324-9218
(909) 222-4073
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-QTMECZ
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487716619
—
CA
Enumeration date
02/17/2023
Last updated
09/06/2024
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