Healthcare Provider Details

I. General information

NPI: 1114445756
Provider Name (Legal Business Name): ESTRELLA P EVANGELISTA DNP, MED, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTRELLA EVANGELISTA MED, DNP, PMHNP-BC

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 GRAND MONTECITO PKWY STE 100
LAS VEGAS NV
89149-0210
US

IV. Provider business mailing address

6605 GRAND MONTECITO PKWY STE 100
LAS VEGAS NV
89149-0210
US

V. Phone/Fax

Practice location:
  • Phone: 702-401-8794
  • Fax:
Mailing address:
  • Phone: 702-401-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number852512
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: