| NPI | 1801661343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROME DIOSTONNE EVANGELISTA Owner 818-625-4814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2023-12-20 |