Healthcare Provider Details

I. General information

NPI: 1821972969
Provider Name (Legal Business Name): EVOKES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15214 LEADWELL ST
VAN NUYS CA
91405-1735
US

IV. Provider business mailing address

15214 LEADWELL ST
VAN NUYS CA
91405-1735
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-9002
  • Fax:
Mailing address:
  • Phone: 818-501-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AIDA GRIGORYAN
Title or Position: PRINCIPAL
Credential:
Phone: 818-426-9207