Healthcare Provider Details

I. General information

NPI: 1023787561
Provider Name (Legal Business Name): EVELYN GEOVANA ROGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14659 OLIVE VIEW DR
SYLMAR CA
91342-1652
US

IV. Provider business mailing address

510 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 818-485-0888
  • Fax:
Mailing address:
  • Phone: 818-485-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW137695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: