Individual provider Active NPI

Evelyn Henar, MD

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1912096553
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A44512 Issued in CA
Practice address
1111 West 6TH Street
Los Angeles, CA 90017-1800
Phone
(213) 975-9626
Fax
(213) 895-0637
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A44512 CA Primary

Addresses

Primary practice location

1111 West 6TH Street
Los Angeles, CA 90017-1800

Mailing address

1600 E Hill Street
Signal Hill, CA 90755-3682
Phone (562) 424-6200

Other identifiers 1

IdentifierTypeStateIssuer
00A445120MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160610001839 CA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 3779873294

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A44512CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Care Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912096553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E HILL STREET",
            "city": "SIGNAL HILL",
            "state": "CA",
            "postal_code": "907553682",
            "telephone_number": "562-424-6200",
            "fax_number": "562-427-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 WEST 6TH STREET",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171800",
            "telephone_number": "213-975-9626",
            "fax_number": "213-895-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENAR",
        "first_name": "EVELYN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A44512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A445120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.