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NPI Code Detail

MEDICARE: JOSEPHINE ARCILLA EVANGELISTA ARNP

MEDICARE: JOSEPHINE ARCILLA EVANGELISTA ARNP
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
1163W00000XRegistered NurseRN60338171WA
2363L00000XNurse PractitionerRN60338171WA
3363L00000XNurse PractitionerNP 15984CA
4363L00000XNurse PractitionerAP60338791WA
5363LA2200XAdult Health Nurse Practitioner15984CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1511361OTHERCAREGISTERED NURSE LICENSE
215984OTHERCANURSE PRACTITIONER LICENS

General Provider Information

NPI Number : 1275704587
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPHINE ARCILLA EVANGELISTA ARNP
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number : 310-301-8707
Fax Number :
Provider Business Practice Location Address
First Line : 2020 SANTA MONICA BLVD STE 600
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2131
Country : US
Telephone Number : 310-826-5471
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2008
Last Update Date : 06/04/2024

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Directions to “ JOSEPHINE ARCILLA EVANGELISTA ARNP” Practice Location

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