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General NPI Number Information
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NPI Number | 1578484713
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Entity Type | Individual
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Provider Name | JOEL MARCIANO EVANGELISTA
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Gender | Male
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 50 COLLEGE DR
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City | NORTH BAY
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State | ONTARIO
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Zip | P1B 5A4
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Country | CA
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 1948 CROWLEY CT
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City | BRENTWOOD
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State | CA
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Zip | 94513-5541
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95457104
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License Number State | CA
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