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General NPI Number Information
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NPI Number | 1063556009
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Entity Type | Individual
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Provider Name | EVANGELINE BISHOP PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 2716 OCEAN PARK BLVD STE 1055
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City | SANTA MONICA
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State | CA
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Zip | 90405-5231
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Country | US
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Telephone | 424-406-1156
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 W 58TH PL
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City | LOS ANGELES
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State | CA
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Zip | 90043-3406
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Country | US
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Telephone | 562-881-9726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY25157
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License Number State | CA
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