MEDICARE: METZLI EVANGELISTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003622804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	METZLI EVANGELISTA

Provider Business Mailing Address
First Line	:	6439 STAFFORD AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6439 STAFFORD AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4214
Country	:	US
Telephone Number	:	323-437-5681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	12/06/2024

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Directions to “ METZLI EVANGELISTA ” Practice Location

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