Healthcare Provider Details

I. General information

NPI: 1982723706
Provider Name (Legal Business Name): EVANGELINE DEOMAMPO LEON-TORRES MPH, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVANGELINE MONTERO DEOMAMPO MPH, CHES

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

1729 VALLEY BEND ST
CHULA VISTA CA
91913-1766
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8023
  • Fax: 619-692-8827
Mailing address:
  • Phone: 619-656-0528
  • Fax: 619-656-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCHES#5648
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: