Healthcare Provider Details

I. General information

NPI: 1225969249
Provider Name (Legal Business Name): JOHN CHRISTOPHER EUGENIO MSN, PMHNP-BC, CCM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 W OLYMPIC BLVD STE 1250W
LOS ANGELES CA
90064-1149
US

IV. Provider business mailing address

11845 W OLYMPIC BLVD STE 1250W
LOS ANGELES CA
90064-1149
US

V. Phone/Fax

Practice location:
  • Phone: 424-373-6435
  • Fax: 424-799-0083
Mailing address:
  • Phone: 424-373-6435
  • Fax: 424-799-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: