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General NPI Number Information
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NPI Number | 1801661343
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Entity Type | Organization
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Legal Business Name | TRUSTFALLS
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 2925 SYCAMORE DR STE 105
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City | SIMI VALLEY
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State | CA
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Zip | 93065-1208
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Country | US
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Telephone | 818-625-4814
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Fax |
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Provider Business Mailing Address
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Address Line | 9250 RESEDA BLVD STE 16
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City | NORTHRIDGE
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State | CA
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Zip | 91324-5213
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Country | US
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Telephone | 818-625-4814
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROME DIOSTONNE EVANGELISTA
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Credential | PMHNP
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Telephone | 818-625-4814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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