IndividualActive
Banisha Evans, CPT LL
NPI 1780342675 · Phlebology Physician · Elk Grove, CA
Provider details
- NPI number
- 1780342675
- Entity type
- Individual
- Primary specialty
- Phlebology PhysicianAllopathic & Osteopathic Physicians
- Credential
- CPT LL
- Sex
- Female
- Sole proprietor
- Yes
- License
- CPA02209141 (CA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
8674 Nemea Way
Elk Grove, CA 95624-3444
Phone: (510) 859-6555
Approximate (ZIP-level) locationGet directions
Mailing address
8674 Nemea Way
Elk Grove, CA 95624-3444
Registry dates
- Enumerated
- 2021-12-07
- Last updated
- 2021-12-07
- Certified
- 2021-12-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.