Individual
BAYANI V. EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
39000 BOB HOPE DR, EISENHOWER IMAGING CENTER, RANCHO MIRAGE, CA 92270-3221
(760) 340-3911
(760) 674-3852
Mailing address
PO BOX 910329, SAN DIEGO, CA 92191-0329
(858) 564-1400
(858) 564-1500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A85985
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A859850
BLUE SHIELD OF CA
CA
05
—
00A859850
—
CA
Enumeration date
05/11/2006
Last updated
05/08/2008
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