Organization
TRUSTFALLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROME DIOSTONNE EVANGELISTA PMHNP (OWNER)
(818) 625-4814
Entity
Organization
Contact information
Practice address
2925 SYCAMORE DR STE 105, SIMI VALLEY, CA 93065-1208
(818) 625-4814
Mailing address
9250 RESEDA BLVD STE 16, NORTHRIDGE, CA 91324-5213
(818) 625-4814
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/15/2023
Last updated
12/20/2023
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