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General NPI Number Information
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NPI Number | 1942087119
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Entity Type | Organization
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Legal Business Name | EVOLVE PSYCHIATRY AND WELLNESS A NURSING CORPORATION
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 1508 BARTON RD STE 216
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City | REDLANDS
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State | CA
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Zip | 92373-1410
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Country | US
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Telephone | 909-895-0546
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Fax | 909-935-1185
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Provider Business Mailing Address
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Address Line | 1508 BARTON RD STE 216
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City | REDLANDS
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State | CA
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Zip | 92373-1410
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Country | US
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Telephone | 909-895-0546
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Fax | 909-935-1185
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Authorized Official
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Title or Position | CEO
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Name | CHOMYA OO
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Credential |
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Telephone | 818-699-2125
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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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