Individual
EVANGELINE VISTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7035 CONVOY CT, SAN DIEGO, CA 92111-1016
(858) 573-0090
Mailing address
24661 LA CRESTA DR, APT 8, DANA POINT, CA 92629-2557
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23592
CA
Other
Enumeration date
03/17/2014
Last updated
04/10/2017
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