Individual
EDIL EVANGELISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN RN PHN FNPC CCRN
Contact information
Practice address
425 DIAMOND DR STE 105, LAKE ELSINORE, CA 92530-4495
(951) 674-8779
Mailing address
27649 PEPPERGRASS CT, MURRIETA, CA 92562-2806
(714) 345-7739
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95012122
CA
Other
Enumeration date
08/28/2019
Last updated
10/01/2019
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