Individual
EDGAR SUNGLAO EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
250 S GRAND AVE, GLENDORA, CA 91741-4218
(626) 857-3299
Mailing address
505 S SHELLMAN AVE, SAN DIMAS, CA 91773-3238
(323) 363-3842
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95006462
CA
Other
Enumeration date
06/20/2017
Last updated
06/20/2017
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