Provider Demographics
NPI:1750781092
Name:CHAMORRO, EVELYN XIOMARA (MA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:XIOMARA
Last Name:CHAMORRO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37509 ROCKIE LN
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12669 ENCINITAS AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3635
Practice Address - Country:US
Practice Address - Phone:800-700-8705
Practice Address - Fax:661-200-1087
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139596106H00000X
CA106647106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor