Healthcare Provider Details

I. General information

NPI: 1902258619
Provider Name (Legal Business Name): CATHERINE EVARISTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N EL MOLINO AVE
PASADENA CA
91101-1675
US

IV. Provider business mailing address

226 N EL MOLINO AVE
PASADENA CA
91101-1675
US

V. Phone/Fax

Practice location:
  • Phone: 818-237-5409
  • Fax: 818-237-5214
Mailing address:
  • Phone: 818-237-5409
  • Fax: 818-237-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT1769
License Number StateCA

VIII. Authorized Official

Name: CATHERINE EVARISTO
Title or Position: OWNER
Credential: OTR/L, CHT
Phone: 818-237-5409