MEDICARE: EVANGELINE BISHOP PSY.D.

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	103T00000X	Psychologist	PSY25157	CA

General Provider Information

NPI Number	:	1063556009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELINE BISHOP PSY.D.

Provider Business Mailing Address
First Line	:	4206 W 58TH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-3406
Country	:	US
Telephone Number	:	562-881-9726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 OCEAN PARK BLVD STE 1055
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5231
Country	:	US
Telephone Number	:	424-406-1156
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/09/2024

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