Healthcare Provider Details

I. General information

NPI: 1023405081
Provider Name (Legal Business Name): EVANGELINE OJALES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST # 6 HARBOR UCLA MEDICAL CENTER- OPHTHALMOLOGY CLINIC 2ND FL
CARSON CA
90810-1408
US

IV. Provider business mailing address

1000 W CARSON ST EYE CLINIC BOX 6
CARSON CA
90810-1408
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2735
  • Fax:
Mailing address:
  • Phone: 310-222-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: