Individual
BANISHA MONAY EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPT LL
Contact information
Practice address
8674 NEMEA WAY, ELK GROVE, CA 95624-3444
(510) 859-6555
Mailing address
8674 NEMEA WAY, ELK GROVE, CA 95624-3444
(510) 859-6555
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
CPA02209141
CA
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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