Basic Information
| Provider Information | |||||||||
| NPI: | 1740381383 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAINSZTEIN | ||||||||
| FirstName: | EVELYN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 PRAIRIE CITY RD | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956309594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163514800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | A70304 | CA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000810778253 | 01 | CA | PHCS | OTHER | 00A703040 | 01 | CA | BLUE SHIELD | OTHER | 1866716 | 01 | CA | FIRST HEALTH | OTHER | 2773899 | 01 | CA | CIGNA | OTHER | 00A70304 | 05 | CA | MEDICAID | 082611 | 01 | CA | HEALTH NET | OTHER | MCMG169200 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 2027039 | 01 | CA | UNITED HEALTHCARE | OTHER | 254734 | 01 | CA | INTERPLAN | OTHER | 7771013 | 01 | CA | AETNA | OTHER | A70304 | 01 | CA | BLUE CROSS | OTHER | 1392870 | 01 | CA | GREAT WEST | OTHER | 90118571 | 01 | CA | PACIFICARE | OTHER |