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General NPI Number Information
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NPI Number | 1396935342
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Entity Type | Individual
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Provider Name | JANISE EVANGELISTA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 17922 SAN FERNANDO MISSION BLVD
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City | GRANADA HILLS
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State | CA
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Zip | 91344-4043
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Country | US
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Telephone | 818-360-1864
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250583
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City | GLENDALE
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State | CA
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Zip | 91225-0583
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 32177
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License Number State | CA
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